Individual provider Active NPI

Alexandra Rose Lauderdale

  • Neonatal Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1639998552
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
12263 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 624-0720
NPI assigned
Oct 8, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 12263 MN Primary
Neonatal Intensive Care Registered Nurse 163WN0002X 2477446 MN

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

1318 S McCoy St
Aberdeen, SD 57401-7843
Phone (605) 377-4479

Other practice location 1

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000

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
I20241115004028 MN Practitioner - Nurse Practitioner 8123552825 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute CurrentSince Nov 16, 2024 Accepting new patients
Fairview Express Care CurrentSince Nov 16, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Nov 16, 2024 Accepting new patients
Fairview Express Care CurrentSince Nov 16, 2024 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

14500 99th Ave N
Ste 500
Maple Grove, MN 55369
Phone (763) 898-1400

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

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

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

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

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: asteckler791307@fairview.direct-ci.com

Organizations & group practices 10

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": "1728345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1639998552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 S MCCOY ST",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574017843",
            "telephone_number": "605-377-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-624-0720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1575 Beam Ave",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551091126",
            "country_code": "US",
            "telephone_number": "651-232-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAUDERDALE",
        "first_name": "ALEXANDRA",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-08",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "MN",
            "license": "12263",
            "primary": true
        },
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "MN",
            "license": "2477446",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.