Active NPI
Diana Drake, NP
- Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1124390729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R100675-7
- Practice address
- 606 24TH Ave S
Suite 300
Minneapolis, MN 55454-1455 - Phone
- (612) 273-7111
- NPI assigned
- Jan 30, 2012
- 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 | R100675-7 | MN | Primary |
Addresses
Primary practice location
606 24TH Ave S
Suite 300
Minneapolis, MN 55454-1455
Mailing address
420 Delaware St SE
MMC 395
Minneapolis, MN 55455-0341
Phone (612) 626-3111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R100675-7 | Other | MN | RN LICENSING BOARD |
Other names 1
- Diana Gorder
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R100675-7 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401926400000",
"number": "1124390729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"address_2": "MMC 395",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "612-626-3111",
"fax_number": "612-626-0665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 24TH AVE S",
"address_2": "SUITE 300",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541455",
"telephone_number": "612-273-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "DIANA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-30",
"last_updated": "2014-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R100675-7",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSING BOARD",
"identifier": "R100675-7",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DIANA",
"last_name": "GORDER",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.