Marisa D Moline, APRN, CNP, CBIS

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R 146976-3 Issued in MN

Practice address

1700 Highway 25 N
Buffalo, MN 55313-1930

Phone

(763) 682-1313

Fax

(763) 581-9090

NPI assigned

Jul 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Child and Adolescent Behavioral Health Services

  dba CABHS Willmar

  • Psychiatric Hospital
  • Willmar, MN
  • NPI 1285760363
  Medicare reassignment NPD
• Karol, PC

  dba Karol Neuropsychological Services & Consulting

  • Clinical Neuropsychologist
  • Eden Prairie, MN
  • NPI 1053383679
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1962425082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131930",
            "telephone_number": "763-682-1313",
            "fax_number": "763-581-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131930",
            "telephone_number": "763-682-1313",
            "fax_number": "763-581-9090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Hart Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "MN",
            "postal_code": "553628929",
            "country_code": "US",
            "telephone_number": "763-295-2921",
            "fax_number": "763-581-9090",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 Nicollet Mall",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554032530",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3675 Ihduhapi Rd",
            "address_purpose": "LOCATION",
            "city": "Loretto",
            "state": "MN",
            "postal_code": "553572120",
            "country_code": "US",
            "telephone_number": "763-479-3555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLINE",
        "first_name": "MARISA",
        "middle_name": "D",
        "credential": "APRN, CNP, CBIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2022-08-09",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "CNP1645",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R 146976-3",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 146976-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255489500",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoline131007@direct.northmemorial.com",
            "affiliation": "N",
            "address_1": "1700 Highway 25 N",
            "city": "Buffalo",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553131930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoline131007@direct.northmemorial.com",
            "affiliation": "N",
            "address_1": "1001 Hart Blvd Ste 100",
            "city": "Monticello",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553628929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robert Milligan, MD
• Tara Rose Minerich, RN
• Minnesota Teen Challenge, Inc (Rockbridge Treatment and Recovery)
• Minnesota Teen Challenge, Inc. (MN Adult & Teen Challenge, Inc.)
• Minnesota Ya Services LLC (Newport Institute-Buffalo)
• Jonathan David Morris
• Brian Moselle
• Robert Thomas Mullaney, M.D.
• Michelle Ann Mulligan
• Kendall Murray, P.T.

• Family Nurse Practitioner in Buffalo, MN
• Providers in Buffalo, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.