Provider Demographics
NPI:1558369322
Name:PATERSON, NICOLE LYNNE (PHARMD BCPS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNNE
Last Name:PATERSON
Suffix:
Gender:F
Credentials:PHARMD BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16116 INVERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4620
Mailing Address - Country:US
Mailing Address - Phone:952-953-9171
Mailing Address - Fax:
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:651-406-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11645631835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy