Provider Demographics
NPI:1164968376
Name:CAGLE, NICOLE L (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:CAGLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:AMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28960 OLD TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9703
Mailing Address - Country:US
Mailing Address - Phone:651-270-7012
Mailing Address - Fax:
Practice Address - Street 1:4638 VICTOR PATH NORTH
Practice Address - Street 2:SUITE 900
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038
Practice Address - Country:US
Practice Address - Phone:651-270-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2252733163W00000X
MN8330363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse