NPIMap

Individual provider Active NPI

Maija L Duppong

  • Family Nurse Practitioner
  • Fosston, MN
National Provider Identifier
1053555797
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R 188975-4 Issued in MN
Practice address
111 2ND St NE
Fosston, MN 56542-1301
Phone
(218) 435-1111
Fax
(218) 435-1112
NPI assigned
Apr 24, 2009
Last updated
Apr 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R 188975-4 MN Primary

Addresses

Primary practice location

111 2ND St NE
Fosston, MN 56542-1301

Mailing address

111 2ND St NE
Fosston, MN 56542-1301
Phone (218) 435-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090604000240 MN Practitioner - Nurse Practitioner 5698825131 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Headwaters Health PCGroup PAC ID 0143718304, 10 clinicians
Bridges Medical CenterGroup PAC ID 4981659851, shared by 3 NPIs, 22 clinicians
Altru Health SystemGroup PAC ID 1355251604, shared by 14 NPIs, 675 clinicians
Lifecare Medical CenterGroup PAC ID 4789586884, 55 clinicians

Practice addresses (Care Compare)

111 2ND St NE
Fosston, MN 56542-1301
Phone (218) 435-1111

1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000

201 9TH St W
Ada, MN 56510-1279
Phone (218) 784-5000

711 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-1365

715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-2500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R 188975-4MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota CurrentSince Jun 29, 2025 Accepting new patients
Lifecare Medical Center CurrentSince Nov 1, 2025 Accepting new patients
Lifecare Medical Center CurrentSince Nov 1, 2025 Accepting new patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Jun 29, 2025 Accepting new patients
Headwaters Health PC CurrentSince Sep 2, 2025 Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

111 2nd St NE
Fosston, MN 56542
Phone (218) 435-1010

715 Delmore Dr
Roseau, MN 56751
Phone (218) 463-2500

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1053555797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 2ND ST NE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421301",
            "telephone_number": "218-435-1111",
            "fax_number": "218-435-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 2ND ST NE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421301",
            "telephone_number": "218-435-1111",
            "fax_number": "218-435-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPPONG",
        "first_name": "MAIJA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-24",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 188975-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fosston, MN

Sources for this page

Verify at the official NPI Registry.