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NPI Code Detail

MEDICARE: NICOLE MARIE SOTO M.D.

MEDICARE: NICOLE MARIE SOTO M.D.
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
1207N00000XDermatology PhysicianMD56521TN
2207N00000XDermatology PhysicianPT16859ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952383226
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE SOTO M.D.
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number : 605-328-6585
Fax Number :
Provider Business Practice Location Address
First Line : 2830 N WASHINGTON ST
Second Line :
City : BISMARCK
State : ND
Zip : 58503-1482
Country : US
Telephone Number : 701-323-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 04/04/2022

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Directions to “ NICOLE MARIE SOTO M.D.” Practice Location

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