Individual
NICOLLE MICHELLE LANDE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2550 UNIVERSITY AVENUE WEST, SUITE 229N, ST PAUL, MN 55114
(651) 645-3115
(651) 645-2752
Mailing address
2550 UNIVERSITY AVENUE WEST, SUITE 229N, ST PAUL, MN 55114
(651) 645-3115
(651) 645-2752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9821
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
486965800
—
MN
01
—
559K0LA
BCBS OF MN
MN
Enumeration date
12/28/2005
Last updated
07/08/2007
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