Individual
NICOLE D SILLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2165 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-2707
(651) 523-9800
Mailing address
7200 VALLEY CREEK PLAZA, WOODBURY, MN 55125-2265
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9401
MN
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
1954
WI
363AM0700X
Medical Physician Assistant
9401
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003756125
MEDICARE #
WI
05
—
42882500
—
WI
05
—
729430100
—
MN
Enumeration date
08/16/2005
Last updated
11/04/2025
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