Provider Demographics
NPI:1336788108
Name:NICHOLLS, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 WESTGATE TRL
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1853
Mailing Address - Country:US
Mailing Address - Phone:952-454-5903
Mailing Address - Fax:
Practice Address - Street 1:586 DODGE AVE NW STE D
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1913
Practice Address - Country:US
Practice Address - Phone:952-454-5903
Practice Address - Fax:833-740-1152
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist