Healthcare Provider Details

I. General information

NPI: 1285120477
Provider Name (Legal Business Name): NICOLE NASH DNP, APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 HENNEPIN AVE N
GLENCOE MN
55336
US

IV. Provider business mailing address

2654 EITEL RD
CHASKA MN
55318-1504
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-3121
  • Fax:
Mailing address:
  • Phone: 612-702-2403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1905175
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2235
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: