Individual
NICOLE KOTTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
141 33RD AVE SOUTH, SAINT CLOUD, MN 56301
(320) 443-6251
Mailing address
141 33RD AVE SOUTH, ST. CLOUD, MN 56303
(320) 443-6251
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
734393
TECHNICIAN LICENCE NUMBER
MN
Enumeration date
09/08/2017
Last updated
07/21/2022
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