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General NPI Number Information
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NPI Number | 1255300885
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Entity Type | Individual
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Provider Name | NICOLE LEA WENTWORTH HARTUNG M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 909 FULTON ST SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-4800
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Country | US
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Telephone | 612-273-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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Country | US
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Telephone |
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 43587
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License Number State | MN
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