Nicole Anne Mukanda, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22890 Issued in MN

Practice address

1825 Chicago Ave
Minneapolis, MN 55404-1939

Phone

(612) 752-8200

Fax

(612) 752-8201

NPI assigned

May 28, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Anne Stulac Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1750904439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041939",
            "telephone_number": "612-752-8200",
            "fax_number": "612-752-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041939",
            "telephone_number": "612-752-8200",
            "fax_number": "612-752-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKANDA",
        "first_name": "NICOLE",
        "middle_name": "ANNE",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-28",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "STULAC",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Muno Shafi Muhumed
• Samiya Ziad Muhumed
• Zahara Muhumed
• Wesley Muilenburg
• Aasiya Sumreen Mujeeb
• Ntwal Abigael Mukaz
• Dhruvika Mukhija, M.D.
• Nehemiah Mukori, RN
• Susan L. Mukunza, RN
• Mulak

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.