Nicolle Renee Ahles-Moses, APRN, CNP
Individual provider Active NPI Pediatric Nurse Practitioner · Coon Rapids, MN
NPI 1902006166 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1902006166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- CNP1814 (MN)
- Practice address
- 10081 Dogwood St NW Ste 100
Coon Rapids, MN 55448-5282 - Phone
- (763) 783-3722
- NPI assigned
- Jul 24, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP1814 | MN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagan Valley Pediatrics, P.a. | Past | Accepting new patients | |
| Today Care | Past | Accepting new patients |
Interoperability endpoints
- nicolle.ahles-moses.1@28275.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | CNP1814 | MN | Yes |
Addresses
Primary practice location
10081 Dogwood St NW Ste 100
Coon Rapids, MN 55448-5282
Mailing address
10081 Dogwood St NW Ste 100
Coon Rapids, MN 55448-5282
Other practice location 1
347 Smith Ave N
Saint Paul, MN 55102-2387
Phone (651) 220-6705
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All providers in Coon Rapids, MN · Pediatric Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.