Healthcare Provider Details

I. General information

NPI: 1962216374
Provider Name (Legal Business Name): NICOLE URBOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

2130 JAMARY PL
SAINT CLOUD MN
56301-3928
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax:
Mailing address:
  • Phone: 320-252-1670
  • Fax: 612-725-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2486151
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: