Provider Demographics
NPI:1760096481
Name:OLIVER, NIKKI LYNN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 WHITEWATER DR STE 125
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4602
Mailing Address - Country:US
Mailing Address - Phone:701-429-3896
Mailing Address - Fax:
Practice Address - Street 1:115 WILLOW ST W STE 4
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3922
Practice Address - Country:US
Practice Address - Phone:701-429-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7686363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health