Provider Demographics
NPI:1811602428
Name:BURROWS, NICOLE MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BURROWS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23829 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-8113
Mailing Address - Country:US
Mailing Address - Phone:218-205-3869
Mailing Address - Fax:
Practice Address - Street 1:820 LILAC DR N STE 210
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4754
Practice Address - Country:US
Practice Address - Phone:763-205-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA171144363LF0000X
FL11021429363LF0000X
NDR35843363LF0000X
WI12246-33363LF0000X
MN8717363LF0000X
SDCP002550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily