Individual
MICAH NICOLE VANDE VEGTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
220 E RIVER PKWY UNIT 428, CHAMPLIN, MN 55316-1426
(712) 395-8621
Mailing address
220 E RIVER PKWY UNIT 428, CHAMPLIN, MN 55316-1426
(712) 395-8621
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F10221396
IA
Other
Enumeration date
12/20/2022
Last updated
12/20/2022
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