Individual
NICOLLE MARIE NICKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
219 GARDEN ST., DULUTH, MN 55812
(763) 439-7831
Mailing address
15642 COBBLESTONE LAKE PKWY, APPLE VALLEY, MN 55124-7829
(763) 439-7831
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R130252-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200613280A
—
KS
05
—
368410500
—
MN
Enumeration date
11/28/2006
Last updated
08/17/2009
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