Individual
MRS. NICOLE ELIZABETH FOGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1200 6TH AVE N, CENTRACARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 656-7020
Mailing address
1200 6TH AVE N, CENTRACARE CLINIC, SAINT CLOUD, MN 56303-2735
(320) 656-7020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11514
MN
363AM0700X
Medical Physician Assistant
Primary
11514
MN
Other
Enumeration date
03/13/2014
Last updated
04/01/2014
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