Provider Demographics
NPI:1922599513
Name:SPALJ, NICOLE (DPM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SPALJ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:COLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 1ST ST N APT 531
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-3363
Mailing Address - Country:US
Mailing Address - Phone:612-875-4806
Mailing Address - Fax:
Practice Address - Street 1:6625 LYNDALE AVE S STE 105
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2673
Practice Address - Country:US
Practice Address - Phone:612-200-8029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN1095213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program