1679303549 NPI number — DR. RANDI NIKKOLINE WICKLUND DNP, FNP-C, CNP

Table of content: DR. RANDI NIKKOLINE WICKLUND DNP, FNP-C, CNP (NPI 1679303549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679303549 NPI number — DR. RANDI NIKKOLINE WICKLUND DNP, FNP-C, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WICKLUND
Provider First Name:
RANDI
Provider Middle Name:
NIKKOLINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP-C, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679303549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
717 E GUSTAVUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-426-4002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W VERNON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-739-2221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  11918 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com