Provider Demographics
NPI:1790002392
Name:VANDENBERG, NICOLE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:KUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350
Mailing Address - Country:US
Mailing Address - Phone:320-587-2020
Mailing Address - Fax:320-484-4686
Practice Address - Street 1:3 CENTURY AVE.
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350
Practice Address - Country:US
Practice Address - Phone:320-587-2020
Practice Address - Fax:320-484-4686
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine