Provider Demographics
NPI:1124260591
Name:ZIVALICH, NICOLE BARTELS (ND)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BARTELS
Last Name:ZIVALICH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 BRYANT AVE S
Mailing Address - Street 2:#104
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405
Mailing Address - Country:US
Mailing Address - Phone:612-801-5195
Mailing Address - Fax:
Practice Address - Street 1:2920 BRYANT AVE S STE 104
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2332
Practice Address - Country:US
Practice Address - Phone:612-801-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist