Active NPI
Olivia Mabberi, APNP
- Nurse Practitioner
- Blaine, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 9918
- Practice address
- 4365 Pheasant Ridge Dr NE Ste 106
Blaine, MN 55449-4544 - Phone
- (888) 938-3838
- Fax
- (888) 919-1083
- NPI assigned
- Feb 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 9918 | MN | Primary |
Addresses
Primary practice location
4365 Pheasant Ridge Dr NE Ste 106
Blaine, MN 55449-4544
Mailing address
10001 W Innovation Dr Ste 200
Milwaukee, WI 53226-4851
Phone (888) 938-3838
Other names 1
- Olivia Nabulwala
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
9325 Upland LN N
Suite 200
Maple Grove, MN 55369-4443
Phone (888) 938-3838
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9918 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ear Institutes, LLC | Current | Accepting new patients | |
| Sama Healthcare | Current | Accepting new patients |
Locations
845 Vikings Pkwy
Ste B
Eagan, MN 55121
Phone (651) 650-0500
6640 Shady Oak Rd
Ste 255
Eden Prairie, MN 55344
9325 Upland Ln N
Ste 200
Maple Grove, MN 55369
2639 Nicollet Ave
Ste 130
Minneapolis, MN 55408
Phone (612) 886-2686
4365 Pheasant Ridge Dr NE
Ste 106
Minneapolis, MN 55449
Phone (763) 296-3277
8401 Seasons Pkwy
Ste 300
Woodbury, MN 55125
10001 W Innovation Dr
Ste 200
Wauwatosa, WI 53226
Interoperability endpoints
- https://api.platform.athenahealth.com/19405/brand/1/csg/1/fhir/r4
- olivia.mabberi.1@19405.direct.athenahealth.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Otolaryngology Physician
- Blaine, MN
- NPI 1881168441
-
- Family Medicine Physician
- Minneapolis, MN
- NPI 1376906388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693872000000",
"number": "1013613660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10001 W INNOVATION DR STE 200",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532264851",
"telephone_number": "888-938-3838",
"fax_number": "888-919-1083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4365 PHEASANT RIDGE DR NE STE 106",
"city": "BLAINE",
"state": "MN",
"postal_code": "554494544",
"telephone_number": "888-938-3838",
"fax_number": "888-919-1083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MABBERI",
"first_name": "OLIVIA",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-06",
"last_updated": "2023-09-05",
"certification_date": "2023-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "9918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "OLIVIA",
"last_name": "NABULWALA",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.