Provider Demographics
NPI:1245549120
Name:WENTLAND, NICOLE LARAE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LARAE
Last Name:WENTLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2926
Mailing Address - Country:US
Mailing Address - Phone:218-263-9109
Mailing Address - Fax:
Practice Address - Street 1:3821 4TH AVE E
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2926
Practice Address - Country:US
Practice Address - Phone:218-263-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR184550-7163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health