Healthcare Provider Details

I. General information

NPI: 1942152921
Provider Name (Legal Business Name): NICOLE HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date: 06/27/2026
Reactivation Date: 07/27/2026

III. Provider practice location address

1017 W CENTRAL ENTRANCE
DULUTH MN
55811-5477
US

IV. Provider business mailing address

4246 TIMBERRIDGE LN APT B
HERMANTOWN MN
55811-4048
US

V. Phone/Fax

Practice location:
  • Phone: 218-481-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14360
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: