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Contact Information

JAN M NICODEMUS
12950 FREMONT AVE STE 102
ZIMMERMAN, MN55398-4629
 Phone: 763-294-0714
 Fax: 763-374-7161
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Home Health Aide

374U00000X
Indicates primary specialty

NPI Profile & details for JAN M NICODEMUS · (Female)

NPI # 1659886448
Status Active
Credentials
Entity Individual
Enumeration date 12/04/2017
Last updated 07/21/2024 - More than a year ago
Sole proprietor 1 No
Identifiers
  • MN License # 10704477
  • MN Other 1083146344 HOME HEALTH AGENCY
  • MN Other 1083146344 PDN
  • MN Other 1083146344 SKILLED NURSING
  • WY Other 1083146344 HOME HEALTH AGENCY
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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