Active NPI
Jessi Elizabeth Nicholson, L.AC. MOM
- Acupuncturist
- Grand Marais, MN
National Provider Identifier
1083987143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 1451
- Practice address
- 101 W Hwy 61
Suite 130
Grand Marais, MN 55604 - Phone
- (218) 370-8378
- Fax
- (218) 387-3584
- NPI assigned
- Feb 20, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1451 | MN | Primary |
Addresses
Primary practice location
101 W Hwy 61
Suite 130
Grand Marais, MN 55604
Mailing address
PO Box 853
Grand Marais, MN 55604
Phone (218) 370-8378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1451 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1083987143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 853",
"city": "GRAND MARAIS",
"state": "MN",
"postal_code": "55604",
"telephone_number": "218-370-8378",
"fax_number": "218-387-3584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 W HWY 61",
"address_2": "SUITE 130",
"city": "GRAND MARAIS",
"state": "MN",
"postal_code": "55604",
"telephone_number": "218-370-8378",
"fax_number": "218-387-3584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "JESSI",
"middle_name": "ELIZABETH",
"credential": "L.AC. MOM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-20",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "MN",
"license": "1451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Marais, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.