Individual
MARY NICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
420 DELAWARE ST SE, MMC 480-UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 625-2654
Mailing address
420 DELAWARE ST SE, MMC 480-UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 625-2654
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9941
MN
363AM0700X
Medical Physician Assistant
9941
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-06279
MEDICA-PRIMARY
MN
01
—
01-19052
MEDICA-CHOICE
MN
01
—
1043048
PREFERRED ONE
MN
01
—
13265
UCARE
MN
01
—
2319537
ARAZ
MN
05
—
41999800
—
WI
05
—
4304742
—
MT
05
—
856458100
—
MN
01
—
HP49622
HEALTHPARTNERS
MN
Enumeration date
10/24/2006
Last updated
05/08/2012
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