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NPI Code Detail

MEDICARE: NICOLE LYNN ULRICH D.O.

MEDICARE:   NICOLE LYNN ULRICH  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician54301MN

General Provider Information

NPI Number : 1093032484
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LYNN ULRICH D.O.
Provider Business Mailing Address
First Line : 4670 PARK NICOLLET AVE SE
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-4119
Country : US
Telephone Number : 952-993-8829
Fax Number :
Provider Business Practice Location Address
First Line : 4670 PARK NICOLLET AVE SE
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-4119
Country : US
Telephone Number : 952-993-8829
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2010
Last Update Date : 05/22/2015

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Directions to “ NICOLE LYNN ULRICH D.O.” Practice Location

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