Nicole Petersen

Primary specialty

Home Health AideTaxonomy code 374U00000X

Practice address

206 Main St N
Velva, ND 58790-7309

Phone

(701) 509-6278

NPI assigned

Oct 10, 2024

Last updated

Oct 10, 2024By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1245050749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 473",
            "city": "VELVA",
            "state": "ND",
            "postal_code": "587900473",
            "telephone_number": "701-509-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MAIN ST N",
            "city": "VELVA",
            "state": "ND",
            "postal_code": "587907309",
            "telephone_number": "701-509-6278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-10",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Krueger, PHARM D
• Kendra L Larsen, FNP-C
• Deanna Rae Mascol
• Marc Miller
• Nicole Wilson Aprn Pmhnp-BC PLLC
• Shelly Jo Pross
• Souris Valley Care Center
• Souris Valley Care Center, Inc. (Souris Valley Care Center)
• Bonnie Jean Thom
• Kim A Thorson, FNP-C

• Home Health Aide in Velva, ND
• Providers in Velva, ND by specialty
• Home Health Aide in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.