Marisa Lynn Pender, DNP, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10596 Issued in MN

Practice address

6452 City West Pkwy
Eden Prairie, MN 55344-3245

Phone

(952) 999-0333

NPI assigned

Oct 30, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Marisa Lynn Shady Former name

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Kingdom Pediatrics LLCGroup PAC ID 7315266806, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• New Kingdom Pediatrics LLC

  • Clinic/Center
  • Eden Prairie, MN
  • NPI 1760816045
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1710454517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6452 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443245",
            "telephone_number": "952-999-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6452 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443245",
            "telephone_number": "952-999-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDER",
        "first_name": "MARISA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-30",
        "last_updated": "2023-08-11",
        "certification_date": "2023-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MN",
            "license": "2466813",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "10596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "SHADY",
            "middle_name": "LYNN",
            "credential": "BSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Theresa Pecha
• Amy Pedersen
• Marilou Pederson, C.P.N.P.
• Pediatric Lab Services Inc
• Linda Ruth Peitzman, M.D.
• Joanne Penn, M.T.
• Pennebaker Clinic of Chiropractic,LLC (Platinum Chiropractoc)
• Bryan Peralta Garces, DPT, PT
• Andrew Michael Perez
• Joselyn Burgos Perez

• Family Nurse Practitioner in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; 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.