Provider Demographics
NPI:1548909229
Name:ALBAUGH, NICOLE CHERIE (APRN - PMHNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHERIE
Last Name:ALBAUGH
Suffix:
Gender:F
Credentials:APRN - PMHNP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:C/O NICOLE ALBAUGH
Mailing Address - Street 2:3148 240TH AVE
Mailing Address - City:ADA
Mailing Address - State:MN
Mailing Address - Zip Code:56510-9315
Mailing Address - Country:US
Mailing Address - Phone:218-394-2774
Mailing Address - Fax:218-394-2780
Practice Address - Street 1:402 3RD ST E STE 12
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MN
Practice Address - Zip Code:56510-1404
Practice Address - Country:US
Practice Address - Phone:218-394-2774
Practice Address - Fax:218-394-2780
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9938364SP0808X, 363LP0808X
NDR34710364SP0809X
MN192799364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family