Provider Demographics
NPI:1467757476
Name:WHITING, NICOLE M (CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:WHITING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:MARTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:166 19TH ST S
Mailing Address - Street 2:STE 101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2154
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:519 22ND AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4652
Practice Address - Country:US
Practice Address - Phone:320-219-7611
Practice Address - Fax:320-219-7612
Is Sole Proprietor?:No
Enumeration Date:2011-01-22
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR164197-6363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500008461Medicare PIN