Provider Demographics
NPI:1457778623
Name:KALAMITSIOTIS, NICOLE (AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:KALAMITSIOTIS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1690 UNIVERSITY AVE W STE 370
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3723
Mailing Address - Country:US
Mailing Address - Phone:651-232-6905
Mailing Address - Fax:651-326-8170
Practice Address - Street 1:1700 UNIVERSITY AVE W FL 6
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-232-6905
Practice Address - Fax:651-326-8170
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005008812363LA2100X
MN4504363LA2200X, 363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology