Active NPI
Maria McGannon
- Pediatric Nurse Practitioner
- Minnetonka, MN
National Provider Identifier
1265418875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R1085503
- Practice address
- 17705 Hutchins Dr
Suite 101
Minnetonka, MN 55345-4145 - Phone
- (952) 401-8300
- NPI assigned
- Dec 16, 2005
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R1085503 | MN | Primary |
Addresses
Primary practice location
17705 Hutchins Dr
Suite 101
Minnetonka, MN 55345-4145
Mailing address
17705 Hutchins Dr
Minnetonka, MN 55345-4145
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 |
|---|---|---|---|
| R1085503 | MN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urgent Care Doctors Office, PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Eden Prairie, MN
- NPI 1447204433
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265418875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17705 HUTCHINS DR",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553454145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17705 HUTCHINS DR",
"address_2": "SUITE 101",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553454145",
"telephone_number": "952-401-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGANNON",
"first_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "R1085503",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.