Provider Demographics
NPI:1346067196
Name:HOUDEK, NICOLIE LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:NICOLIE
Middle Name:LYNN
Last Name:HOUDEK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NICOLIE
Other - Middle Name:LYNN
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6550 YORK AVE S STE 211
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2333
Mailing Address - Country:US
Mailing Address - Phone:952-225-5400
Mailing Address - Fax:952-225-5405
Practice Address - Street 1:6550 YORK AVE S STE 211
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2333
Practice Address - Country:US
Practice Address - Phone:952-225-5400
Practice Address - Fax:952-225-5405
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily