Provider Demographics
NPI:1053686618
Name:SIMPSON MITCHELL, NIKOLE M
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:M
Last Name:SIMPSON MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5116
Mailing Address - Country:US
Mailing Address - Phone:763-568-6739
Mailing Address - Fax:
Practice Address - Street 1:777 5TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5116
Practice Address - Country:US
Practice Address - Phone:763-568-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNP506121614211374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula