Provider Demographics
NPI:1033100987
Name:NASH, VICKIE L (MD)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30017207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
50A50NAOtherBLUE CROSS BLUE SHIELD
836595400OtherMEDICAL ASSISTANCE
110424OtherU-CARE
2113977OtherFIRST HEALTH PLAN
160001180OtherMEDICARE
254012OtherPREFERRED ONE
556195OtherARAZ GRP/AMERICA'S PPO
HP25493OtherHEALTH PARTNERS
0702777OtherMEDICA HEALTH PLANS
E40281Medicare UPIN