Individual provider Active NPI

Madonna Carmel McNulty, APRN, CNP

  • Family Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1790558666
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
10965 Issued in MN
Practice address
402 E 2ND St
Duluth, MN 55805-1906
Phone
(218) 786-4000
NPI assigned
Nov 2, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 10965 MN Primary

Addresses

Primary practice location

402 E 2ND St
Duluth, MN 55805-1906

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240124000550 MN Practitioner - Nurse Practitioner 6204288491 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Northern Pines Medical CenterGroup PAC ID 3870565641, 39 clinicians

Practice addresses (Care Compare)

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

5211 Hwy 110
Aurora, MN 55705-1522
Phone (218) 229-3311

Hospital & facility affiliations

  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • Essentia Health Northern Pines Medical Center Hospital, Aurora, MN, CCN 241340
  • Essentia Health Virginia Hospital, Virginia, MN, CCN 240084

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Medical Center CurrentSince Aug 18, 2024 Accepting new patients
The Duluth Clinic, LTD CurrentSince Dec 4, 2023 Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
Northern Pines Medical Center CurrentSince Dec 4, 2023 Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Dec 4, 2023 Accepting new patients
Pine Medical Center CurrentSince Aug 18, 2024 Accepting new patients
Deer River Healthcare Center, Inc CurrentSince Dec 4, 2023 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Dec 4, 2023 Accepting new patients
Northern Pines Medical Center CurrentSince Jan 1, 2026 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients

Locations

5211 Highway 110
Aurora, MN 55705
Phone (218) 229-1010

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

Organizations & group practices 10

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1698883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1790558666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051906",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNULTY",
        "first_name": "MADONNA",
        "middle_name": "CARMEL",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-02",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "10965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.