Individual
NICOLE RAE BANICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-6000
Mailing address
7620 BOWMAN CT, INVER GROVE HEIGHTS, MN 55076-2907
(651) 492-8144
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2455
MN
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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