Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nickolas C Southwick, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1023617362

Nickolas C Southwick, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Plymouth, Minnesota. Qualified in 2020, 6 years ago. Practices with University Anesthesia Providers LLC, a 332-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
6
Licensed in
MN
In the registry since
2020
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

14700 28th Ave N Ste 20
Plymouth, MN 55447-4876
Phone: (763) 559-3779
Fax: (763) 450-3986
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2104 Northdale Blvd Nw Ste 220, Coon Rapids, MN 55433-3046 — (763) 537-6000

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 2342009 (MN)

Record details

NPI number1023617362
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedOctober 19, 2020
Last updated in NPPESNovember 24, 2025
Certification dateNovember 24, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice University Anesthesia Providers Llc — 332 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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