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General NPI Number Information
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NPI Number | 1205581683
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Entity Type | Individual
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Provider Name | NIKKI PLYS
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 2827 CHAMBERSBURG AVE
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City | DULUTH
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State | MN
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Zip | 55811-3004
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Country | US
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Telephone | 218-340-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 LINCOLN ST
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City | SUPERIOR
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State | WI
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Zip | 54880-6716
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Country | US
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Telephone | 218-340-9766
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 28612
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License Number State | MN
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