Individual
NICOLE RENEE PROSSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25945 GATEWAY DR, ZIMMERMAN, MN 55398-5300
(763) 856-6900
Mailing address
25945 GATEWAY DR, ZIMMERMAN, MN 55398-5300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9576
MN
Other
Enumeration date
05/12/2006
Last updated
05/19/2008
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