Healthcare Provider Details

I. General information

NPI: 1689943250
Provider Name (Legal Business Name): NICOLE C LI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FOURIER DR STE 200
MADISON WI
53717-1958
US

IV. Provider business mailing address

1001 FOURIER DR STE 200
MADISON WI
53717-1958
US

V. Phone/Fax

Practice location:
  • Phone: 608-740-2001
  • Fax:
Mailing address:
  • Phone: 608-740-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7321
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7321-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10376
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: