Provider Demographics
NPI:1588683726
Name:CRICK, NICHOLINE F (APNP)
Entity Type:Individual
Prefix:
First Name:NICHOLINE
Middle Name:F
Last Name:CRICK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COLLEGE AVE W
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-2116
Mailing Address - Country:US
Mailing Address - Phone:715-748-7502
Mailing Address - Fax:715-748-7590
Practice Address - Street 1:320 E MAIN
Practice Address - Street 2:
Practice Address - City:GILMAN
Practice Address - State:WI
Practice Address - Zip Code:54433
Practice Address - Country:US
Practice Address - Phone:715-447-8293
Practice Address - Fax:715-447-8270
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1160-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43928800Medicaid
S58762Medicare UPIN
WI43928800Medicaid