Nicolle Marie Nicklas, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R130252-9 Issued in MN

Practice address

219 Garden St.
Duluth, MN 55812

Phone

(763) 439-7831

NPI assigned

Nov 28, 2006

Last updated

Aug 17, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesiology, P.a.Group PAC ID 9335033034, 136 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Anesthesiology, P.a.

  • Anesthesiology Physician
  • Robbinsdale, MN
  • NPI 1013960798

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD

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

• North Memorial Health Care

  dba North Memorial Ambulance Service

  • Ambulance
  • Brooklyn Center, MN
  • NPI 1538195912

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  dba North Memorial Health Specialty Center - Robbinsdale

  • Medical Specialty Clinic/Center
  • Robbinsdale, MN
  • NPI 1699953000

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  dba North Memorial Health Hospital

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Care Compare affiliation

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250467200000",
    "number": "1073689295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15642 COBBLESTONE LAKE PKWY",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247829",
            "telephone_number": "763-439-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 GARDEN ST.",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55812",
            "telephone_number": "763-439-7831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAS",
        "first_name": "NICOLLE",
        "middle_name": "MARIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2009-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R130252-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200613280A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "368410500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Nguyen
• James Frederick Nicholas
• Paige Olivia Nichols
• Anna Nick
• Michele Rae Nick
• Rochelle L Niehues, LICSW
• Kenneth Walter Niejadlik
• Bruce D Nielsen, CRNA
• Ronald Marvin Niemi
• Matthew Adam Nierengarten, APRN, CNP

• Certified Registered Nurse Anesthetist in Duluth, MN
• Providers in Duluth, MN by specialty
• Certified Registered Nurse Anesthetist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.