Provider Demographics
NPI:1417319633
Name:NIKLE, ANNE BOYD (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BOYD
Last Name:NIKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 14TH ST NW STE 240
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-0007
Mailing Address - Country:US
Mailing Address - Phone:763-571-4000
Mailing Address - Fax:763-502-2966
Practice Address - Street 1:11107 ULYSSES ST NE STE 200
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4264
Practice Address - Country:US
Practice Address - Phone:763-571-4000
Practice Address - Fax:763-502-2966
Is Sole Proprietor?:No
Enumeration Date:2016-03-26
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN70032207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology