Provider Demographics
NPI:1902103658
Name:UBAN, NICOLLE MARIE (PHD, APRN, CNM)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:MARIE
Last Name:UBAN
Suffix:
Gender:F
Credentials:PHD, APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GILLIS AVE NE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3131
Mailing Address - Country:US
Mailing Address - Phone:218-828-7773
Mailing Address - Fax:218-828-2976
Practice Address - Street 1:117 GILLIS AVE NE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3131
Practice Address - Country:US
Practice Address - Phone:218-828-7773
Practice Address - Fax:218-828-2976
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 128894-4367A00000X
MNCNM0226367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife