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General NPI Number Information
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NPI Number | 1770420671
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Entity Type | Individual
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Provider Name | JULIE ANN NICKLASON RN
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Gender | Female
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 210 PLEASANT ST W
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City | NEVIS
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State | MN
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Zip | 56467-4466
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Country | US
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Telephone | 218-652-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 210 PLEASANT ST W
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City | NEVIS
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State | MN
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Zip | 56467-4466
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 2228521
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License Number State | MN
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