Healthcare Provider Details

I. General information

NPI: 1205499464
Provider Name (Legal Business Name): NICOLETTE GINDELE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W DIVISION ST STE 215
SAINT CLOUD MN
56301-4557
US

IV. Provider business mailing address

3333 W DIVISION ST STE 215
SAINT CLOUD MN
56301-4557
US

V. Phone/Fax

Practice location:
  • Phone: 320-382-5140
  • Fax: 320-238-7839
Mailing address:
  • Phone: 320-382-5140
  • Fax: 320-238-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10557
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: