Individual
NICOLE M DISHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3625 W 65TH ST STE 100, EDINA, MN 55435-2147
(952) 920-7001
(952) 920-2245
Mailing address
10900 WAYZATA BLVD STE 640, MINNETONKA, MN 55305-5602
(561) 208-5734
(561) 208-5734
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R44853
NM
176B00000X
Midwife
CNM647
NM
367A00000X
Advanced Practice Midwife
Primary
304
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H400317380
MEDICARE
MN
Enumeration date
05/15/2013
Last updated
11/21/2022
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