Individual provider Active NPI

Michelle A Devereaux, GNP

  • Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1164496535
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
481 Issued in MN
Practice address
4730 Chicago Ave
Minneapolis, MN 55407-3570
Phone
(952) 883-6805
NPI assigned
Feb 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 481 MN Primary

Addresses

Primary practice location

4730 Chicago Ave
Minneapolis, MN 55407-3570

Mailing address

8170 33Rd Ave S
Bloomington, MN 55425-4516
Phone (952) 883-6805

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100603000793 MN Practitioner - Nurse Practitioner 8022147883 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
481MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Oct 23, 2025 Accepting new patients
Park Nicollet Clinic CurrentSince Oct 23, 2025 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Group Health, Inc. CurrentSince Dec 27, 2001 Accepting new patients
Group Health, Inc. CurrentSince Dec 27, 2001 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

4730 Chicago Ave
Minneapolis, MN 55407
Phone (612) 313-0000

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

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

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

3850 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 883-1000

Organizations & group practices 6

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 5

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": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1164496535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-883-6805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073570",
            "telephone_number": "952-883-6805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVEREAUX",
        "first_name": "MICHELLE",
        "middle_name": "A",
        "credential": "GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.