Provider Demographics
NPI:1962634691
Name:NICHOLSON, NATALIE M (NP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:802 PAUL BUNYAN DR S STE 12&13
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3201
Mailing Address - Country:US
Mailing Address - Phone:218-444-4323
Mailing Address - Fax:218-444-7514
Practice Address - Street 1:802 PAUL BUNYAN DR S STE 12&13
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3201
Practice Address - Country:US
Practice Address - Phone:218-444-4323
Practice Address - Fax:218-444-7514
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR158189-0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner