DR. NICOLE LYNN ROEDER (NPI# 1568737716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568737716 |
| Entity Type | Individual |
| Full Name | DR. NICOLE LYNN ROEDER |
| Other Name | DR. NICOLE BOURNIVAL |
| Credential | MD |
| Practice Address |
1575 Beam Ave Maplewood MN 55109 |
| Mailing Address |
1575 Beam Ave Maplewood MN 55109-1126 |
| Practice Telephone | 6512327000 |
| Mailing Telephone | 6032641335 |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2018-05-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
63495 | MN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 20 York St, New Haven, CT 065103220 | 2036885555 | 2036884516 |
| Street Address |
1575 BEAM AVE |
| City | MAPLEWOOD |
| State | MN |
| Zip Code | 55109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366447468 | Darcy Ross Mcbride | Radiology | 1575 Beam Ave, Health East Cancer Care, Maplewood, MN 55109-1126 | 2005-06-15 |
| 1851857627 | Ashley Marie Vold | Physician Assistant | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2019-02-15 |
| 1972075406 | Baylee Nahan | Physician Assistant | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2018-12-21 |
| 1770087058 | Anna Rae Shelley | Genetic Counselor, MS | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2018-03-21 |
| 1922508605 | Jason Krier | Nurse Anesthetist, Certified Registered | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2018-02-19 |
| 1568970051 | Rachel Holen | Emergency Medicine | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2018-01-18 |
| 1366959652 | Gabrielle Mae Blia Lee | Interpreter | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2018-01-08 |
| 1962925479 | Yeng Lor | Interpreter | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2017-07-18 |
| 1396268801 | De Mo Soe | Interpreter | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2017-07-18 |
| 1437672946 | Way Ber | Interpreter | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2017-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063828 | Jodi May Begordis | Registered Nurse | 2586 7th Ave East, Suite 302, North St Paul, MN 55109 | 2020-05-06 |
| 1467917146 | Alejandro Diez Freire | Social Worker | 2468 Germain St, Maplewood, MN 55109 | 2019-02-06 |
| 1679099667 | Rochelle Marie Clarke | Registered Nurse | 2586 7th Ave East Suite 302, North Saint Paul, MN 55109 | 2017-08-21 |
| 1497298210 | Salams Care Residential, LLC | Home Health | 2240 Ide Ct, Maplewood, MN 55109 | 2016-11-28 |
| 1093199630 | Garry Allen | Psychologist | 2345 Ariel St North Mail Stop 13601a, Maplewood, MN 55109 | 2015-07-14 |
| 1700264751 | Matthew Seng Thao | Student in an Organized Health Care Education/Training Program | 1470 Gervais Ave, Maplewood, MN 55109 | 2015-05-11 |
| 1326458340 | Chong Chang | Counselor | 1705 Cope Ave E Ste I, Maplewood, MN 55109 | 2014-04-29 |
| 1619396488 | Leah Anne Downey | Occupational Therapist | 2399 Ariel St. N., Children's Theraplay, LLC, Maplewood, MN 55109 | 2014-04-09 |
| 1356765440 | Group Health Plan, Inc | Clinic/Center | 2520 12th Ave E, North St Paul, MN 55109 | 2014-02-10 |
| 1336560275 | Veneman Dental Care, Pa | Dentist | 1774 Cope Ave, Suite 110, Maplewood, MN 55109 | 2013-12-19 |
| Find all providers in zip 55109 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548789910 | Sleepmedrx LLC | Internal Medicine | 7701 York Ave S Ste 100, Edina, MN 55435-5849 | 2017-09-16 |
| 1033354097 | Norman G Hepper | Internal Medicine | 1809 Hiawatha Ct Ne, Rochester, MN 55906-8014 | 2008-12-04 |
| 1841447083 | John Mcdougall | Internal Medicine | 1460 75th St Ne, Rochester, MN 55906-8903 | 2008-08-19 |
| 1396867909 | Abbie Lynn Begnaud | Internal Medicine | 516 Delaware Street, Clinic 6a, Umphysicians Medicine Specialties Clinic, Minneapolis, MN 55455 | 2007-04-04 |
| 1114068863 | Northwind Lung Specialists, P.a. | Internal Medicine | 3758 Coon Rapids Blvd Nw, Coon Rapids, MN 55433-2629 | 2007-02-08 |
| 1679593925 | Joan Mk Fox | Internal Medicine | 920 E 28th St # St5, Suite 700, Minneapolis, MN 55407-1139 | 2006-07-20 |
| 1871534214 | James W Leatherman | Internal Medicine | 701 Park Ave S, S1, Minneapolis, MN 55415-1623 | 2006-06-09 |
| 1649225012 | Conrad Iber | Internal Medicine | 606 24th Avenue South, Suite 106, Ump Sleep Medicine Clinic, Minneapolis, MN 55454-1437 | 2006-05-24 |
| 1831162395 | Jannica L Groom | Internal Medicine | 401 Phalen Boulevard, Mail Stop 41, St Paul, MN 55101-5302 | 2006-02-07 |
| 1194700864 | Sue Ann Ravenscraft | Internal Medicine | Park Nicollet Clinic Meadowbrook, 6490 Excelsior Blvd # W300, St Louis Park, MN 55426 | 2005-12-14 |
| Find all providers with the same taxonomy | ||||
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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.