Individual provider Active NPI

Amanda Dubuque, CNP

  • Family Nurse Practitioner
  • Lakeville, MN
National Provider Identifier
1568874931
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
187211-4 Issued in MN
Practice address
18580 Joplin Ave
Lakeville, MN 55044-4218
Phone
(952) 892-9555
NPI assigned
May 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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 187211-4 MN Primary

Addresses

Primary practice location

18580 Joplin Ave
Lakeville, MN 55044-4218

Mailing address

18580 Joplin Ave
Lakeville, MN 55044-4218
Phone (952) 892-9555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140929000841 MN Practitioner - Nurse Practitioner 8729208681 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

11725 Stinson Ave
Chisago City, MN 55013-9542
Phone (651) 257-8499

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (952) 914-1732

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
187211-4MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Aug 8, 2014 Accepting new patients
Fairview Express Care CurrentSince Jun 1, 2016 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Jun 1, 2016 Accepting new patients
Fairview Health Services CurrentSince Jun 1, 2016 Accepting new patients
Fairview Clinics CurrentSince Jun 1, 2016 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Aug 8, 2014 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

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

11725 Stinson Ave
Chisago City, MN 55013
Phone (651) 257-8421

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

18580 Joplin Ave
Lakeville, MN 55044
Phone (952) 892-9500

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

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

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

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

Interoperability endpoints

  • Direct secure messaging: adubuque194989@fairview.direct-ci.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": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400544000000",
    "number": "1568874931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18580 JOPLIN AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550444218",
            "telephone_number": "952-892-9555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18580 JOPLIN AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550444218",
            "telephone_number": "952-892-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBUQUE",
        "first_name": "AMANDA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-20",
        "last_updated": "2014-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "187211-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

Verify at the official NPI Registry.