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General NPI Number Information
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NPI Number | 1386194462
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Entity Type | Individual
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Provider Name | NICOLE MARIE COLE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 13045 FALCON DR STE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone | 218-282-4746
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Fax | 182-829-7649
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Provider Business Mailing Address
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Address Line | 13045 FALCON DR STE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone | 218-282-4746
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Fax | 218-829-7649
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12219
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12219
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License Number State | MN
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