Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CNP 1100 | MN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | F0710512 | MN |
NPI | 1003126707 |
---|---|
Provider Name | Nicole Irene Ellingson Williams |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Belle Plaine, MN 56011-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2010 |
Last Update Date | 11/03/2021 |