Basic Information
| Provider Information | |||||||||
| NPI: | 1528164571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNCAN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | O.T.R./L., C.H.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E 1ST ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187225513 | ||||||||
| FaxNumber: | 2186252757 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E 1ST ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187225513 | ||||||||
| FaxNumber: | 2186252757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 02/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 102309 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 6401170 | 01 | MN | MN MEDICA INDIVIDUAL | OTHER | 51B83DU | 01 | MN | BCBS MN INDIVIDUAL | OTHER | 40827800 | 05 | WI | MEDICAID | 368620500 | 05 | MN | MEDICAID |