=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699657130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE LOXTERKAMP APRN, NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 ELM ST N
-----------------------------------------------------
City | ONAMIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56359-7901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-532-3154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14297 OAK RIDGE DR
-----------------------------------------------------
City | LITTLE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56345-6479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-630-1633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 13611
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------