Active NPI
Christine Fossum, CNP
- Family Nurse Practitioner
- Roseville, MN
National Provider Identifier
1770113748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 6366
- Practice address
- 2277 Highway 36 W Ste 140
Roseville, MN 55113-3895 - Phone
- (507) 934-7161
- NPI assigned
- Jan 18, 2020
- Last updated
- Mar 13, 2021
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 6366 | MN | Primary |
Addresses
Primary practice location
2277 Highway 36 W Ste 140
Roseville, MN 55113-3895
Mailing address
2277 Highway 36 W Ste 140
Roseville, MN 55113-3895
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)
- Not enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6366 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615593600000",
"number": "1770113748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2277 HIGHWAY 36 W STE 140",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551133895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2277 HIGHWAY 36 W STE 140",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551133895",
"telephone_number": "507-934-7161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSSUM",
"first_name": "CHRISTINE",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-18",
"last_updated": "2021-03-13",
"certification_date": "2021-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "6366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.