MEDICARE: NICOLE LYNNE PATERSON PHARM.D. BCPS

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
1	1835P1200X	Pharmacotherapy Pharmacist	1164563	MN

General Provider Information

NPI Number	:	1558369322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LYNNE PATERSON PHARM.D. BCPS

Provider Business Mailing Address
First Line	:	16116 INVERNESS WAY
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-4620
Country	:	US
Telephone Number	:	952-953-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 CENTRAL PARK VILLAGE DR
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-7707
Country	:	US
Telephone Number	:	651-406-8860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/09/2019

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