NICHOLAS MOORE SOUTHERTON

MINNEAPOLIS, MN
NPI1013691153
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LG0600X Nurse Practitioner, Gerontology
(Licence: MN  10301)
Enumeration Date2023-06-09
Last Update Date2023-06-20
Business Address
NICHOLAS MOORE SOUTHERTON CNP
1415 LILAC DR N
MINNEAPOLIS, MN 55422-4500
Phone number: 763-205-4168
Mailing Address
NICHOLAS MOORE SOUTHERTON CNP
2124 144TH LN NE
HAM LAKE, MN 55304-6260
Phone number: 763-248-4011
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