Individual
NICHOLLE CO NACIONALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4645 TRENTON CIR N, PLYMOUTH, MN 55442-3146
(763) 234-7928
Mailing address
4645 TRENTON CIR N, PLYMOUTH, MN 55442-3146
(763) 234-7928
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14764
MN
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/02/2021
Last updated
01/03/2024
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