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Individual

NICHOLE MARIE FAIRBANKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2501 RICE LAKE RD, DULUTH, MN 55811-4819
(218) 625-6400
(218) 625-6452
Mailing address
804 HAMILTON DR, DULUTH, MN 55811-5924

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
12904
WI
225100000X
Physical Therapist
Primary
9006
MN

Other

Enumeration date
11/20/2014
Last updated
11/20/2014
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