NICOLLE MARIE NICKLAS (NPI# 1073689295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073689295 |
| Entity Type | Individual |
| Full Name | NICOLLE MARIE NICKLAS |
| Credential | CRNA |
| Practice Address |
219 Garden St. Duluth MN 55812 |
| Mailing Address |
15642 Cobblestone Lake Pkwy Apple Valley MN 55124-7829 |
| Practice Telephone | 7634397831 |
| Mailing Telephone | 7634397831 |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2009-08-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | R130252-9 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 368410500 | 05 | |
| KS | 200613280A | 05 |
| Street Address |
219 GARDEN ST. |
| City | DULUTH |
| State | MN |
| Zip Code | 55812 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942743950 | Thomas Anthony Olson | Specialist/Technologist | 1049 Ordean Court, 170 Sports & Health Center, Duluth, MN 55812 | 2016-11-22 |
| 1922457183 | Zen Eye Care Pllc | Optometrist | 2106 London Road, Duluth, MN 55812 | 2016-06-08 |
| 1295134088 | Charla Buxbaum | Specialist/Technologist | 1216 Ordean Ct. Sphc 170, University of Minnesota Duluth, Duluth, MN 55812 | 2014-08-18 |
| 1346473998 | Patricia A Trachte | Nurse Practitioner | 107 Ksc, Umd Quick Care, Duluth, MN 55812 | 2009-08-31 |
| 1003088543 | Arrowhead House Inc | Community Based Residential Treatment Facility, Mental Illness | 16 South 18th Avenue East, Duluth, MN 55812 | 2008-03-25 |
| 1346328762 | Timothy Patrick Stratton | Pharmacist | 386a Kirby Plaza, 1208 Kirby Drive, Duluth, MN 55812 | 2006-11-02 |
| 1316960701 | Questar Duluth, Inc | Specialist | 1527 London Road, Duluth, MN 55812 | 2006-07-26 |
| 1063401297 | Clinton T Moen | Specialist | 2711 E 5th St, Duluth, MN 55812 | 2005-10-20 |
| 1124016563 | Christine Aas-larson | Nurse Practitioner | 1502 London Road, Suite 102, Duluth, MN 55812 | 2005-10-10 |
| 1831731645 | Krystal Mueller | Behavior Technician | 1522 E Superior St, Duluth, MN 55812 | 2019-10-14 |
| Find all providers in zip 55812 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285139865 | Levi Garrett La Porte | Nurse Anesthetist, Certified Registered | Duluth Clinic, 400 East Third Street, Duluth, MN 55805-1951 | 2018-03-27 |
| 1538326137 | Shawn C Lewis | Nurse Anesthetist, Certified Registered | 2938 Major Ridge Trl, Anesthesia Department, Duluth, GA 30097-4985 | 2008-05-21 |
| 1215947064 | Jacalyn Ann Hoecker | Nurse Anesthetist, Certified Registered | 920 E 1st St Ste P-101, Pavilion Surgery Center, Duluth, MN 55805-2201 | 2006-08-08 |
| 1326098377 | Christopher J Lafleur | Nurse Anesthetist, Certified Registered | 3704 Allendale Ave, Duluth, MN 55803-1829 | 2006-05-11 |
| 1952360653 | Joan Eileen Jay | Nurse Anesthetist, Certified Registered | 2620 Satellite Blvd, Duluth, GA 30096-1204 | 2006-03-21 |
| 1386250454 | Erin Elizabeth Kukowski | Nurse Anesthetist, Certified Registered | 400 E 3rd St, Duluth, MN 55805-1951 | 2020-09-23 |
| 1083246136 | Kristin L Schomburg | Nurse Anesthetist, Certified Registered | 407 E 3rd St, Duluth, MN 55805-1950 | 2020-02-06 |
| 1316598949 | David Lloyd Johnson | Nurse Anesthetist, Certified Registered | 915 E 1st St, Duluth, MN 55805-2107 | 2019-09-25 |
| 1962050906 | Brandon S Percival | Nurse Anesthetist, Certified Registered | 400 E Third Street, Duluth, MN 55805-1951 | 2019-09-03 |
| 1265087829 | Joseph M Autio | Nurse Anesthetist, Certified Registered | 400 E 3rd St, Duluth, MN 55805-1951 | 2019-08-09 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.