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NPI Code Detail

MEDICARE: NICOLE KWAPICK

MEDICARE: NICOLE KWAPICK
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
1363A00000XPhysician Assistant11891MN

General Provider Information

NPI Number : 1609251628
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE KWAPICK
Provider Business Mailing Address
First Line : 2025 SLOAN PL STE 35
Second Line :
City : SAINT PAUL
State : MN
Zip : 55117-2092
Country : US
Telephone Number : 651-772-1572
Fax Number :
Provider Business Practice Location Address
First Line : 3550 LABORE RD STE 7
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55110-5113
Country : US
Telephone Number : 651-766-0520
Fax Number : 651-766-9451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2015
Last Update Date : 10/26/2023

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Directions to “ NICOLE KWAPICK ” Practice Location

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