Active NPI
Alyssa Catherine Tiedens, MS, ATC
- Athletic Trainer
- Maple Grove, MN
National Provider Identifier
1346786761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2859
- Practice address
- 9177 Oakview LN N
Maple Grove, MN 55369-6505 - Phone
- (763) 232-6394
- NPI assigned
- Jan 9, 2017
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2859 | MN | Primary |
Addresses
Primary practice location
9177 Oakview LN N
Maple Grove, MN 55369-6505
Mailing address
501 Old Town Drive
New Brighton, MN 55112
Phone (763) 232-6394
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000014006 | Other | BOARD OF CERTIFICATION |
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2859 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493078400000",
"number": "1346786761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 OLD TOWN DRIVE",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "55112",
"telephone_number": "763-232-6394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9177 OAKVIEW LN N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553696505",
"telephone_number": "763-232-6394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIEDENS",
"first_name": "ALYSSA",
"middle_name": "CATHERINE",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-09",
"last_updated": "2017-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2859",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF CERTIFICATION",
"identifier": "2000014006",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.