Active NPI
Gail A Fellman, GNP
- Nurse Practitioner
- Bloomington, MN
National Provider Identifier
1689648230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R1128703
- Practice address
- 8170 33Rd Ave S
Mc21110Q
Bloomington, MN 55425-4516 - Phone
- (952) 883-6805
- Fax
- (952) 883-6117
- NPI assigned
- Feb 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R1128703 | MN | Primary |
Addresses
Primary practice location
8170 33Rd Ave S
Mc21110Q
Bloomington, MN 55425-4516
Mailing address
8170 33Rd Ave S
Mc21110Q
Bloomington, MN 55425-4516
Phone (952) 883-6805
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 482400800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1128703 | MN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208304000000",
"number": "1689648230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"address_2": "MC21110Q",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554254516",
"telephone_number": "952-883-6805",
"fax_number": "952-883-6117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"address_2": "MC21110Q",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554254516",
"telephone_number": "952-883-6805",
"fax_number": "952-883-6117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FELLMAN",
"first_name": "GAIL",
"middle_name": "A",
"credential": "GNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-13",
"last_updated": "2008-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R1128703",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "482400800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.