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General NPI Number Information
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NPI Number | 1902103658
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Entity Type | Individual
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Provider Name | NICOLLE MARIE UBAN PHD, APRN, CNM
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Gender | Female
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 117 GILLIS AVE NE
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City | BRAINERD
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State | MN
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Zip | 56401-3131
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Country | US
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Telephone | 218-828-7773
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Fax | 218-828-2976
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Provider Business Mailing Address
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Address Line | 117 GILLIS AVE NE
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City | BRAINERD
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State | MN
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Zip | 56401-3131
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Country | US
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Telephone | 218-828-7773
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Fax | 218-828-2976
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | R 128894-4
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | CNM0226
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License Number State | MN
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