Provider Demographics
NPI:1528362886
Name:NICKOLAUSON, WENDY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:NICKOLAUSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24761 HEARTLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEVIS
Mailing Address - State:MN
Mailing Address - Zip Code:56467
Mailing Address - Country:US
Mailing Address - Phone:218-652-4603
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE N
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL056788-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse