Provider Demographics
NPI:1538514658
Name:NICHOL, HEIDI RENAE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RENAE
Last Name:NICHOL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:RENAE
Other - Last Name:HARTWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:763-581-9090
Practice Address - Street 1:1001 HART BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8929
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:763-684-3603
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62599207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine