Healthcare Provider Details

I. General information

NPI: 1790404812
Provider Name (Legal Business Name): NICOLE ANDREA ARDUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 3RD ST SE
OSSEO MN
55369-1609
US

IV. Provider business mailing address

508 3RD ST SE
OSSEO MN
55369-1609
US

V. Phone/Fax

Practice location:
  • Phone: 612-315-0353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4840
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: