Individual
GLENN A NICKELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
216 S ADAMS ST, SAINT CROIX FALLS, WI 54024-9449
(715) 483-3221
(715) 483-0507
Mailing address
235 STATE STREET, ST. CROIX FALLS, WI 54024-4117
(715) 483-3261
(715) 483-0507
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
32220
WI
207RC0000X
Cardiovascular Disease Physician
42548
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
468980100
—
MN
Enumeration date
02/27/2006
Last updated
06/12/2024
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