Healthcare Provider Details

I. General information

NPI: 1063094647
Provider Name (Legal Business Name): NICOLE MURA LICHTER APRN-CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 12TH ST N
NEW TOWN ND
58763-4149
US

IV. Provider business mailing address

618 12TH ST N
NEW TOWN ND
58763-4149
US

V. Phone/Fax

Practice location:
  • Phone: 701-421-3513
  • Fax:
Mailing address:
  • Phone: 701-421-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number203424
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR38127
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: