Healthcare Provider Details

I. General information

NPI: 1447652300
Provider Name (Legal Business Name): NICOLE HYLDEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE LINDA DEHEN

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S COLUMBIA RD
GRAND FORKS ND
58201-4030
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5400
  • Fax:
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR36029
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: