Provider Demographics
NPI:1285120477
Name:NASH, NICOLE (DNP, APRN, CRNA)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:DNP, APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 EITEL RD
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1504
Mailing Address - Country:US
Mailing Address - Phone:612-702-2403
Mailing Address - Fax:
Practice Address - Street 1:1805 HENNEPIN AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336
Practice Address - Country:US
Practice Address - Phone:320-864-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1905175163WC0200X
MN2235367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine