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General NPI Number Information
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NPI Number | 1063094647
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Entity Type | Individual
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Provider Name | NICOLE MURA LICHTER APRN-CNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 618 12TH ST N
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City | NEW TOWN
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State | ND
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Zip | 58763-4149
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Country | US
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Telephone | 701-421-3513
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Fax |
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Provider Business Mailing Address
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Address Line | 618 12TH ST N
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City | NEW TOWN
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State | ND
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Zip | 58763-4149
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Country | US
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Telephone | 701-421-3513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 203424
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R38127
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License Number State | ND
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