Individual
JODI M NICHOLSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1527 BROADWAY ST, ALEXANDRIA, MN 56308-2537
(320) 762-0399
(320) 762-6847
Mailing address
1527 BROADWAY ST, ALEXANDRIA, MN 56308-2537
(320) 762-0399
(320) 762-6847
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9998
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0121310
MEDICA
MN
01
—
1043861
PREFERRED ONE
MN
01
—
2360626
AMERICA'S PPO
MN
01
—
318G2NI
BLUE SHIELD
MN
01
—
A029
CHAMPUS
MN
01
—
HP53165
HEALTH PARTNERS
MN
Enumeration date
01/26/2006
Last updated
07/08/2007
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