Provider Demographics
NPI:1679638381
Name:NICOLLET PUBLIC SCHOOL DISTRICT 507
Entity type:Organization
Organization Name:NICOLLET PUBLIC SCHOOL DISTRICT 507
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:EUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-232-3411
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:NICOLLET
Mailing Address - State:MN
Mailing Address - Zip Code:56074-0108
Mailing Address - Country:US
Mailing Address - Phone:507-232-3411
Mailing Address - Fax:507-232-3536
Practice Address - Street 1:1 PINE STREET
Practice Address - Street 2:
Practice Address - City:NICOLLET
Practice Address - State:MN
Practice Address - Zip Code:56074
Practice Address - Country:US
Practice Address - Phone:507-232-3411
Practice Address - Fax:507-232-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN864662700OtherMA PROVIDER #