Provider Demographics
NPI:1316320005
Name:NIQUE, JUDITH (LPN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:NIQUE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3731
Mailing Address - Country:US
Mailing Address - Phone:507-456-7010
Mailing Address - Fax:
Practice Address - Street 1:301 PARK DR
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5639
Practice Address - Country:US
Practice Address - Phone:507-451-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN732637183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician