NPIMap

Individual provider Active NPI

Nicole Marie Siddons, DNP, RN, APRN, FNP-C

  • Family Nurse Practitioner
  • Saint Paul, MN
National Provider Identifier
1467803403
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP 4589 Issued in MN
Practice address
1700 University Ave W FL 1
Saint Paul, MN 55104-3727
Phone
(651) 232-2002
NPI assigned
Jun 30, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP 4589 MN Primary

Addresses

Primary practice location

1700 University Ave W FL 1
Saint Paul, MN 55104-3727

Mailing address

1689 Lenox Dr
Waconia, MN 55387-4535
Phone (920) 217-9035

Other practice location 1

1689 Lenox Dr
Waconia, MN 55387-4535
Phone (920) 217-9035

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161031000174 MN Practitioner - Nurse Practitioner 7113205923 Reassigns benefits to 5 organizations
I20250109000944 WI Practitioner - Nurse Practitioner 7113205923 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Minnesota Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Lights Health LLCGroup PAC ID 6305278797, 11 clinicians

Practice addresses (Care Compare)

212 W Lake St
Waconia, MN 55387-1014
Phone (651) 603-4565

750 E Louisiana St
Saint Croix Falls, WI 54024-9501
Phone (715) 483-9815

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.69 of 100Reported as group
Quality
91.97
Improvement activities
40
Cost
69.67

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4589MNMDPhysical Therapist
CNP 4589MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Northern Lights Health LLC Family CurrentSince Dec 15, 2019 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care CurrentSince Apr 9, 2019 Accepting new patients
Fairview Clinics CurrentSince Apr 9, 2019 Accepting new patients
Minnesota Disc Institute, PA CurrentSince Jul 12, 2021 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services CurrentSince Apr 9, 2019 Accepting new patients
Waterside Healthcare & Wellness, LLC Family CurrentSince Dec 29, 2019 Accepting new patients
Healtheast Medical Research Institute CurrentSince Oct 6, 2017 Accepting new patients
Fairview Express Care CurrentSince Feb 11, 2021 Accepting new patients
Fairview Express Care CurrentSince Feb 11, 2021 Accepting new patients

Locations

303 E Nicollet Blvd
Ste 160
Burnsville, MN 55337
Phone (952) 460-4000

6936 Pine Arbor Dr S
Ste 100
Cottage Grove, MN 55016
Phone (651) 326-5800

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

7300 France Ave S
Ste 350
Minneapolis, MN 55435
Phone (952) 500-8090

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

2945 Hazelwood St
Ste 100
Saint Paul, MN 55109
Phone (651) 232-7800

1875 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

750 E Louisiana St
Saint Croix Falls, WI 54024
Phone (715) 483-2713

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 33

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1467803403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1689 LENOX DR",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874535",
            "telephone_number": "920-217-9035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W FL 1",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727",
            "telephone_number": "651-232-2002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1689 Lenox Dr",
            "address_purpose": "LOCATION",
            "city": "Waconia",
            "state": "MN",
            "postal_code": "553874535",
            "country_code": "US",
            "telephone_number": "920-217-9035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIDDONS",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "DNP, RN, APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-30",
        "last_updated": "2022-07-21",
        "certification_date": "2019-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP 4589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.