Individual provider Active NPI

Shari L Landreville

  • Critical Care Neonatal Nurse Practitioner
  • Maplewood, MN
National Provider Identifier
1689310294
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X
License
11386 Issued in MN
Practice address
2945 Hazelwood St Ste 100
Maplewood, MN 55109-1242
Phone
(651) 471-9400
NPI assigned
May 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Neonatal Nurse Practitioner 363LN0005X 67925 NM
Critical Care Neonatal Nurse Practitioner 363LN0005X 11386 MN Primary

Addresses

Primary practice location

2945 Hazelwood St Ste 100
Maplewood, MN 55109-1242

Mailing address

1700 University Ave W FL 6
Saint Paul, MN 55104-3727

Other practice location 1

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone (505) 272-3172

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address UNMH@direct.health.unm.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11386MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Unm Medical Group, Inc. CurrentSince Jul 22, 2022 Accepting new patients
Unm Medical Group Inc CurrentSince Jul 22, 2022 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care CurrentSince Mar 11, 2024 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Mar 11, 2024 Accepting new patients
Fairview Express Care CurrentSince Mar 11, 2024 Accepting new patients
Healtheast Medical Research Institute CurrentSince Mar 11, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients

Locations

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

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

933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

Organizations & group practices 8

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": "1651795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1689310294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W FL 6",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 HAZELWOOD ST STE 100",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091242",
            "telephone_number": "651-471-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2211 Lomas Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871062719",
            "country_code": "US",
            "telephone_number": "505-272-3172",
            "fax_number": "505-272-3028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDREVILLE",
        "first_name": "SHARI",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-06",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "NM",
            "license": "67925",
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "MN",
            "license": "11386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMH@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "2211 Lomas Blvd NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871062719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

Verify at the official NPI Registry.