Provider Demographics
NPI:1326534108
Name:HUNTER, NICOLE IRENE (APRN CNM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:IRENE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 EXCELSIOR BLVD STE 585
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-6400
Mailing Address - Country:US
Mailing Address - Phone:612-345-5920
Mailing Address - Fax:844-562-6828
Practice Address - Street 1:3033 EXCELSIOR BLVD STE 585
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-6400
Practice Address - Country:US
Practice Address - Phone:612-345-5920
Practice Address - Fax:844-562-6828
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1578311367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife