Tina Marie Allenburg, NURSE PRACTITIONER
Individual provider Active NPI Nurse Practitioner · Minneapolis, MN
NPI 1013028281 · NPPES record last updated Sep 10, 2008
Key facts
- NPI
- 1013028281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R119816-0 (MN)
- Practice address
- 3300 Oakdale Ave N
Suite 200
Minneapolis, MN 55422-2926 - Phone
- (763) 520-2000
- Fax
- (763) 520-2099
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lakewood Health System
Practice addresses (Care Compare)
49725 County
Suite 83
Staples, MN 56479-5280
Phone (218) 894-1515
Hospital & facility affiliations
- Lakewood Health System
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050325000067 | MN | Practitioner - Nurse Practitioner | 9436105129 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R119816-0 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakewood Health System | Current |
Accepting new patients | |
| North Memorial Health Care | Current |
Accepting new patients | |
| Lakewood Health System | Current |
Accepting new patients | |
| North Memorial Health Care | Current | Accepting new patients | |
| Lakewood Health System | Current |
Accepting new patients | |
| Clinical Practice Management, P.C. | Past | Accepting new patients |
Locations
9855 Hospital Dr
Ste 104
Maple Grove, MN 55369
Phone (763) 581-5900
9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000
3300 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 520-2000
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
49725 County 83
Staples, MN 56479
Phone (218) 894-1033
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R119816-0 | MN | Yes |
Addresses
Primary practice location
3300 Oakdale Ave N
Suite 200
Minneapolis, MN 55422-2926
Mailing address
4905 W 66TH Street
Edina, MN 55435
Phone (612) 396-0553
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43995700 | Medicaid | WI | |
| 3054977-00 | Medicaid | MN |
Other names
- Tina Marie Wegrzyn
Other providers in Minneapolis, MN
- Tadashi Leonard Allen
- Timothy Allen
- William Allen II
- William D. Allen I
- Paula A Allenburg
- Allergy & Asthma Specialists, PA
- Katie Ann Alley
- Kaylin Grace Alley
- Alliance Clinic
- Alliance Clinic, LLC
All providers in Minneapolis, MN · Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.