Provider Demographics
NPI:1003126707
Name:WILLIAMS, NICOLE IRENE ELLINGSON (MS, RN, CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:IRENE ELLINGSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:PO BOX 1309 MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-993-4900
Mailing Address - Fax:
Practice Address - Street 1:700 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-1000
Practice Address - Country:US
Practice Address - Phone:952-873-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 160797 8163W00000X
MNF0710512363LF0000X
MNCNP 1100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse