Healthcare Provider Details

I. General information

NPI: 1770420671
Provider Name (Legal Business Name): JULIE ANN NICKLASON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PLEASANT ST W
NEVIS MN
56467-4466
US

IV. Provider business mailing address

210 PLEASANT ST W
NEVIS MN
56467-4466
US

V. Phone/Fax

Practice location:
  • Phone: 218-652-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number2228521
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: