Provider Demographics
NPI:1457549594
Name:ECKMAN, NIKKI J (CRNA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:J
Last Name:ECKMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:J
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0001
Mailing Address - Country:US
Mailing Address - Phone:701-234-5621
Mailing Address - Fax:701-234-7334
Practice Address - Street 1:737 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4421
Practice Address - Country:US
Practice Address - Phone:701-234-5621
Practice Address - Fax:701-234-7334
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29368207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN237122100Medicaid
ND14454Medicaid
MN237122100Medicaid
ND14454Medicaid