Healthcare Provider Details

I. General information

NPI: 1538023593
Provider Name (Legal Business Name): NICOLE URBANIAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11595 GRENELEFE AVE N
SAINT PAUL MN
55110-1236
US

IV. Provider business mailing address

11595 GRENELEFE AVE N
SAINT PAUL MN
55110-1236
US

V. Phone/Fax

Practice location:
  • Phone: 651-357-8317
  • Fax:
Mailing address:
  • Phone: 651-357-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2491516
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: