Provider Demographics
NPI:1558188011
Name:STURM, NICOLE ANGELA (LNA)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ANGELA
Last Name:STURM
Suffix:
Gender:F
Credentials:LNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 KOCH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5082
Mailing Address - Country:US
Mailing Address - Phone:701-260-7603
Mailing Address - Fax:
Practice Address - Street 1:1053 KOCH ST APT 201
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5082
Practice Address - Country:US
Practice Address - Phone:701-260-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND142323374U00000X, 251G00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based