Individual
NICOLE M. GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8800
Mailing address
2400 32ND AVE S, FARGO, ND 58103-5800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11974
ND
207Q00000X
Family Medicine Physician
R-8325
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16268
—
ND
Enumeration date
06/12/2008
Last updated
01/19/2012
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