Female

Nicolle M. Lande PA

Physician Assistant in St Paul, MN(View on Map)

Full Name

Nicolle Michelle Lande PA

NPI Number

1881671162

NPI Type

Individual Provider

Gender

Female

Enumeration Date

12/28/2005

Specialties

(Taxonomies)

Code

363A00000X

Primary Taxonomy

Yes

Licenses

State

Minnesota

License Number

9821

Contact
Information

Purpose

Mailing
Location

Address

2550 UNIVERSITY AVENUE WEST
2550 UNIVERSITY AVENUE WEST

City

St Paul
St Paul

State

MN
MN

Postal Code

55114
55114

Country

US
US

Telephone Number

(651) 645-3115
(651) 645-3115

Identifiers

Identifier

486965800
559K0LA

Identifier State

MN
MN

Identifier Issuer

Unknown
BCBS OF MN

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/08/2007

Provider Address

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