NPIMap

Individual provider Active NPI

Nicole Anderson

  • Adult Health Nurse Practitioner
  • North Branch, MN
National Provider Identifier
1477964336
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
AG0614167 Issued in MN
Practice address
5366 386TH St NE
North Branch, MN 55056-5833
Phone
(651) 674-8353
NPI assigned
May 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R1795291 MN
Adult Health Nurse Practitioner 363LA2200X AG0614167 MN Primary

Addresses

Primary practice location

5366 386TH St NE
North Branch, MN 55056-5833

Mailing address

9778 Pine Shores Dr
Pine City, MN 55063-4575

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140929001016 MN Practitioner - Nurse Practitioner 3870713746 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Welia HealthGroup PAC ID 6709295496, 60 clinicians

Practice addresses (Care Compare)

301 Hwy 65 S
Mora, MN 55051-1899
Phone (320) 679-1212

Hospital & facility affiliations

  • Adara Home Health Inc Home health agency, Buffalo, MN, CCN 248056
  • Accentcare Fairview Home Health - West, LLC Home health agency, Saint Paul, MN, CCN 247078
  • Welia Health Hospital, Mora, MN, CCN 241367

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3072MNMDMental Health Counselor
AG0614167MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Clinics CurrentSince Oct 2, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Welia Health Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Health Services CurrentSince Aug 8, 2014 Accepting new patients
Fairview Health Services Current Accepting new patients
Welia Health CurrentSince Jul 5, 2022 Accepting new patients
Fairview Clinics CurrentSince Oct 2, 2020 Accepting new patients
Fairview Health Services CurrentSince Aug 8, 2014 Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

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

620 Sandy Ln
Hinckley, MN 55037
Phone (320) 384-6189

400 Stinson Blvd
#2
Minneapolis, MN 55413
Phone (612) 672-2294

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

301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317

5366 386th St NE
North Branch, MN 55056
Phone (651) 674-6800

1425 Main St N
Pine City, MN 55063
Phone (320) 322-5141

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

Interoperability endpoints

  • Direct secure messaging: nanderson46263@excellian.direct.allina.com

Organizations & group practices 12

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1477964336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9778 PINE SHORES DR",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550634575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 386TH ST NE",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550565833",
            "telephone_number": "651-674-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-14",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R1795291",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "AG0614167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Branch, MN

Sources for this page

Verify at the official NPI Registry.