Nicole Szudy Buatala, RN, MSN, FNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5299 Issued in MN

Practice address

2103 County Road D E Ste B
Maplewood, MN 55109-5358

Phone

(651) 748-5019

Fax

(651) 383-4529

NPI assigned

Jul 25, 2017

Last updated

Feb 10, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Nicole Marie Szudy Former name

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Innovations IncGroup PAC ID 6204178528, 96 clinicians

Danielle Golden, Crna, PAGroup PAC ID 6305934597, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.nicolebuatala@149810.advancedmd-direct.com

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.

• Danielle Golden, Crna, PA

  dba The Remedy

  • Adult Mental Health Clinic/Center
  • Vadnais Heights, MN
  • NPI 1598954687

  WI

  Medicare reassignment Care Compare group NPD
• Family Innovations, Inc.

  dba LifeStance Health

  • Counseling Psychologist
  • Anoka, MN
  • NPI 1992862783

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Fraser Child and Family Center

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1609922194
  Medicare reassignment NPD
• Baldwin Area Medical Center, Inc.

  dba Western Wisconsin Health

  • Critical Access Hospital
  • Baldwin, WI
  • NPI 1467496133
  Medicare reassignment NPD
• Baldwin Area Medical Center Inc.

  dba Western Wisconsin Health Spring Valley Clinic

  • Clinic/Center
  • Spring Valley, WI
  • NPI 1164272324
  NPD
• Baldwin Area Medical Center, Inc.

  dba Western Wisconsin Health

  • Rural Health Clinic/Center
  • Baldwin, WI
  • NPI 1336228865
  NPD
• Fraser

  • Rehabilitation Clinic/Center
  • Richfield, MN
  • NPI 1063568574
  NPD (past)
• West Central Counseling LLC

  • Mental Health Counselor
  • Alexandria, MN
  • NPI 1649846650
  NPD (past)

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1568985257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 COUNTY ROAD D E STE B",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095358",
            "telephone_number": "651-748-5019",
            "fax_number": "651-383-4529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 COUNTY ROAD D E STE B",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095358",
            "telephone_number": "651-748-5019",
            "fax_number": "651-383-4529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUATALA",
        "first_name": "NICOLE",
        "middle_name": "SZUDY",
        "credential": "RN, MSN, FNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-25",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "5299",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "9918",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "5299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "SZUDY",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Selina Marie Brugler, CNP
• Steven J Bruin, PHARMD
• Chelsea Brumme, LPCC
• Frank Joseph Brumme, LPCC
• Jacqueline Lea Bryant, RN
• Cole Anthony Buchtel, L.I.C.S.W
• Joseph William Budenske, MD
• Samantha Buerger
• William David Bunce, DDS
• Craig Jay Buning, DPT

• Psychiatric/Mental Health Nurse Practitioner in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.