Active NPI
Nicole Lindy Diveley, PHARMD
- Pharmacist
- Moorhead, MN
National Provider Identifier
1427605021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH6392
- Practice address
- 801 Belsly Blvd
Moorhead, MN 56560-5055 - Phone
- (701) 364-6800
- Fax
- (701) 364-6828
- NPI assigned
- Aug 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 6669 | SD | |
| Pharmacist | 183500000X | 12727 | MN | |
| Pharmacist | 183500000X | RPH6392 | ND | Primary |
Addresses
Primary practice location
801 Belsly Blvd
Moorhead, MN 56560-5055
Mailing address
801 Belsly Blvd
Moorhead, MN 56560-5055
Phone (701) 364-6800
Other names 1
- Nicole Lindy Rasmussen
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH6392 | ND | MD | Pharmacist |
| 6669 | SD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660521600000",
"number": "1427605021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 BELSLY BLVD",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605055",
"telephone_number": "701-364-6800",
"fax_number": "701-364-6828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BELSLY BLVD",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605055",
"telephone_number": "701-364-6800",
"fax_number": "701-364-6828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVELEY",
"first_name": "NICOLE",
"middle_name": "LINDY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-20",
"last_updated": "2022-08-15",
"certification_date": "2022-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SD",
"license": "6669",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "12727",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ND",
"license": "RPH6392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "RASMUSSEN",
"middle_name": "LINDY",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.