Provider Demographics
NPI:1477749554
Name:HENTGES, NICOLE MARIE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:HENTGES
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21897 S DIAMOND LAKE RD
Mailing Address - Street 2:# 403
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4642
Mailing Address - Country:US
Mailing Address - Phone:612-865-5262
Mailing Address - Fax:763-565-3306
Practice Address - Street 1:5520 RIDGEWOOD CV
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-8239
Practice Address - Country:US
Practice Address - Phone:612-865-5262
Practice Address - Fax:763-565-3306
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR161296-3364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology