NPIMap

Individual provider Active NPI

Nicholas Peter Wanner, PA-C

  • Physician Assistant
  • Eagan, MN
National Provider Identifier
1124564240
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12349 Issued in MN
Practice address
1885 Plaza Dr
Eagan, MN 55122-2979
Phone
(952) 993-4001
NPI assigned
Jan 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 12349 MN Primary

Addresses

Primary practice location

1885 Plaza Dr
Eagan, MN 55122-2979

Mailing address

1885 Plaza Dr
Eagan, MN 55122-2979
Phone (952) 993-4001

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
I20170220001288 MN Practitioner - Physician Assistant 9032492970 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

1500 Curve Crest W Blvd
Stillwater, MN 55082-6040
Phone (651) 439-1234

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

921 Greeley S St
Stillwater, MN 55082-5935
Phone (651) 439-1234

Hospital & facility affiliations

  • Lakeview Homecare Home health agency, Oak Park Heights, MN, CCN 248008
  • Lakeview Memorial Hospital Hospital, Stillwater, MN, CCN 240066
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
12349MNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Mar 27, 2017 Accepting new patients
Park Nicollet Clinic CurrentSince Mar 27, 2017 Accepting new patients
Group Health, Inc. CurrentSince Feb 2, 2022 Accepting new patients
Group Health, Inc. CurrentSince Feb 2, 2022 Accepting new patients
Group Health, Inc. Past Accepting new patients
Lakeview Memorial Hospital Association Inc. Past Accepting new patients
Group Health, Inc. Past Accepting new patients

Locations

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

1885 Plaza Dr
Saint Paul, MN 55122
Phone (952) 993-4001

1500 Curve Crest Blvd W
Stillwater, MN 55082

927 Churchill St W
Stillwater, MN 55082
Phone (651) 430-4529

Organizations & group practices 8

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755216000000",
    "number": "1124564240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 PLAZA DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222979",
            "telephone_number": "952-993-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1885 PLAZA DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222979",
            "telephone_number": "952-993-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNER",
        "first_name": "NICHOLAS",
        "middle_name": "PETER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-12",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.