Provider Demographics
NPI:1952445900
Name:OMANN, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:OMANN
Other - Last Name:KAMPSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:347 SMITH AVE N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2387
Mailing Address - Country:US
Mailing Address - Phone:651-220-6700
Mailing Address - Fax:
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6700
Practice Address - Fax:651-220-6807
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics