Individual
NICOLE ALTSTATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4786 BANNING AVE, WHITE BEAR LAKE, MN 55110-3264
(612) 579-0597
Mailing address
15830 FARNHAM AVE N, HUGO, MN 55038-9002
(651) 503-7263
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
CNP 4271
MN
363LF0000X
Family Nurse Practitioner
Primary
CNP 4271
MN
Other
Enumeration date
11/11/2015
Last updated
02/13/2019
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