PARK NICOLLET (NPI# 1174975528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174975528 |
| Entity Type | Organization |
| Organization Name | PARK NICOLLET |
| Practice Address |
9555 Upland Ln N Maple Grove MN 55369-4485 |
| Mailing Address |
7102 Olive Ln N Maple Grove MN 55311-3573 |
| Practice Telephone | 9529931440 |
| Mailing Telephone | 7634944686 |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-07-11 |
| Authorized Official Name | BERNT HELGAAS (MEDICAL DIRECTOR PARK NICOLLET MGRC) |
| Authorized Official Telephone | 9529931440 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982150728 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 66369 | 2016-08-31 |
| 1265840888 | Park Nicollet | Clinic/Center | 15111 Twelve Oaks Center Dr, Minnetonka, MN 55305-5201 | 2014-07-28 |
| 1053623785 | Park Nicollet | Clinic/Center | 8455 Flying Cloud Dr, Eden Prairie, MN 55344-3974 | 2010-07-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK NICOLLET CLINIC | 3800 Pk Nicollet Blvd, Minneapolis, MN 55416-2527 |
| Oklahoma Business Registrations | PARK NICOLLET MEDICAL FOUNDATION | 5000 W 39th. St., St Louis Park, MN 55416 |
| System for Award Management (SAM) Entities | PARK NICOLLET METHODIST HOSPITAL | 6500 Excelsior Blvd, Saint Louis Park, MN 55426-4702 |
| Street Address |
9555 UPLAND LN N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4485 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568453926 | David C Sandell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2005-11-03 |
| 1114528593 | Dana Marie Feia | Physician Assistant | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-11-03 |
| 1235741364 | Relevium Chiropractic Care Pa | Chiropractor | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-08-19 |
| 1467012872 | Bethany Wysocki | Audiologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2019-06-18 |
| 1487168357 | Dusty Renee Hackler | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-11-29 |
| 1841722469 | Brynne Rainier Wilson Latterell | Family Medicine | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2017-04-02 |
| 1982150728 | Park Nicollet | Clinic/Center | 9555 Upland Ln N, Maple Grove, MN 66369 | 2016-08-31 |
| 1528514932 | David Chollar | Social Worker | 9555 Upland Ln N, Behavioral Health, 3rd Floor, Maple Grove, MN 55369-4485 | 2016-08-27 |
| 1770037574 | Biye Tambang | Nurse Practitioner | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-08-09 |
| 1780038299 | Elizabeth Patricia Kratz | Nurse Practitioner | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2016-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760429237 | Roger S Hogue Md Pa | Clinic/Center | 7365 Kirkwood St N, Ste 120, Maple Grove, MN 55369 | 2006-06-01 |
| 1457619116 | North Memorial Health Care | Clinic/Center | 9855 Hospital Dr, Suite 102b, Maple Grove, MN 55369-4648 | 2012-05-01 |
| 1730485186 | Allina Health System | Clinic/Center | 7840 Vinewood Ln N, Maple Grove, MN 55369-7185 | 2011-02-02 |
| 1811223662 | Fairview Health Services | Clinic/Center | 14500 99th Ave N, Ste 1a038, Maple Grove, MN 55369-4478 | 2009-10-29 |
| 1558696583 | Allina Health System | Clinic/Center | 9600 Upland Ln N, Maple Grove, MN 55369-4494 | 2009-10-08 |
| 1871721845 | Fairview Health Services | Clinic/Center | 6320 Wedgewood Rd N, Ste 131, Maple Grove, MN 55311-3647 | 2009-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871191403 | Cham Clinic LLC | Clinic/Center | 7362 University Ave Ne Ste 206, Fridley, MN 55432-3151 | 2020-10-15 |
| 1003434622 | Lost Lake Optical Company | Clinic/Center | 5240 Shady Island Cir, Mound, MN 55364-9222 | 2020-07-09 |
| 1811513310 | Prescribed By LLC | Clinic/Center | 701 Washington Ave N Ste 111-321, Minneapolis, MN 55401-2822 | 2020-06-19 |
| 1992320014 | Jtp Professional Service Corporation | Clinic/Center | 2038 Ford Pkwy # 444, Saint Paul, MN 55116-1931 | 2020-06-15 |
| 1689299125 | Altru Health System | Clinic/Center | 1st & Roosevelt, Karlstad, MN 56732 | 2020-06-10 |
| 1831710409 | Webmed LLC | Clinic/Center | 925 E Superior St Ste 113, Duluth, MN 55802-2253 | 2020-05-05 |
| 1073149779 | Functional Chiropractic Rehab, Pllc | Clinic/Center | 1901 Madison Ave Ste 120, Mankato, MN 56001-6267 | 2020-03-14 |
| 1225676067 | Liana Healthcare P.ll.c | Clinic/Center | 8348 Beard Rd, Bloomington, MN 55431-1028 | 2019-12-11 |
| 1245875293 | Fairview Clinics | Clinic/Center | 12912 Farnham Ave N, White Bear Lake, MN 55110-5929 | 2019-11-14 |
| 1275175242 | Hye-kyong Kim Therapy LLC | Clinic/Center | 1145 Grand Ave # 101, Saint Paul, MN 55105-2629 | 2019-10-11 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
Please comment or provide details below to improve the information on PARK NICOLLET.
| 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.