Active NPI
Nancy Grace Shaddi
- Psychiatric/Mental Health Nurse Practitioner
- Andover, MN
National Provider Identifier
1831771427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 8148
- Practice address
- 1353 161St LN NW
Andover, MN 55304-5067 - Phone
- (651) 208-7331
- NPI assigned
- Apr 23, 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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 8148 | MN | Primary |
Addresses
Primary practice location
1353 161St LN NW
Andover, MN 55304-5067
Mailing address
1353 161St LN NW
Andover, MN 55304-5067
Phone (651) 208-7331
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8148 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1831771427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1353 161ST LN NW",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553045067",
"telephone_number": "651-208-7331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1353 161ST LN NW",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553045067",
"telephone_number": "651-208-7331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADDI",
"first_name": "NANCY",
"middle_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-23",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MN",
"license": "8148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.