Individual
MISS NICOLE ANN SCANLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
480 OSBORNE RD NE STE 260, FRIDLEY, MN 55432-2866
(763) 236-5000
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9390
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2022
Last updated
12/20/2023
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