NICOLE ALTSTATT (NPI# 1982077061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982077061 |
| Entity Type | Individual |
| Full Name | NICOLE ALTSTATT |
| Credential | CNP |
| Practice Address |
4786 Banning Ave White Bear Lake MN 55110-3264 |
| Mailing Address |
15830 Farnham Ave N Hugo MN 55038-9002 |
| Practice Telephone | 6125790597 |
| Mailing Telephone | 6515037263 |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2019-02-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | CNP 4271 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
CNP 4271 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3800 Lexington Ave N, Shoreview, MN 551262916 | 6514860048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982947693 | Nicole Altstatt | Psychologist | 1111 Route 25a, Stony Brook, NY 11790-1907 | 2013-04-01 |
| Street Address |
4786 BANNING AVE |
| City | WHITE BEAR LAKE |
| State | MN |
| Zip Code | 55110-3264 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831141886 | Ann M Barry | Family Medicine | 4786 Banning Ave, White Bear Lake, MN 55110 | 2006-05-17 |
| 1346713476 | Maria Elizabeth Cook | Physician Assistant | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2019-01-11 |
| 1730520008 | Nicole Marie Harvey | Physician Assistant | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2013-07-15 |
| 1366751562 | Minnesota Institute for Pain Management, LLC | Physical Medicine & Rehabilitation | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2010-10-05 |
| 1356668123 | Stacy Marie Smith | Physician Assistant | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2010-05-03 |
| 1639359359 | Family Healthservices Minnesota, P.a. | Family Medicine | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2007-11-09 |
| 1871710988 | Minnhealth Family Physicians, P.a. | Family Medicine | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2007-04-19 |
| 1720120645 | Family Healthservices Minnesota, P.a | Non-Pharmacy Dispensing Site | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2007-02-14 |
| 1972510634 | David C Thorson | Family Medicine | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2006-08-02 |
| 1063428746 | Carol K Stark | Family Medicine | 4786 Banning Ave, White Bear Lake, MN 55110-3264 | 2006-08-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467071084 | St. Catherine University School Based Health Clinic | Nurse Practitioner | 5045 Division Ave, White Bear Lake, MN 55110 | 2020-04-14 |
| 1922450618 | Lisa Marie Thatcher | Podiatrist | 4653 White Bear Pkwy., St. Paul, MN 55110 | 2016-07-06 |
| 1558725598 | White Bear Dentists, PC | Dentist | 1970 Buerkle Road, White Bear Lake, MN 55110 | 2016-04-06 |
| 1124486246 | Julie Blaske | Counselor | 1310 Hwy 96 E, Suite 200, White Bear Lake, MN 55110 | 2016-02-03 |
| 1851761514 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 1920 Buerkle Rd, White Bear Lake, MN 55110 | 2015-10-06 |
| 1821496969 | Leah Eichmiller | Acupuncturist | 2183 3rd Street, C/o Indulge Salon, White Bear Lake, MN 55110 | 2014-12-05 |
| 1447672084 | Ashley Rath | Chiropractor | 1247 Gun Club Rd., White Bear Lake, MN 55110 | 2014-01-16 |
| 1790121291 | Advanced Medical Home Care, LLC | Home Health | 2555 County Road E East, Suite 101, White Bear Lake, MN 55110 | 2013-05-11 |
| 1134468465 | Emergency Physicians Professional Association | Clinic/Center | 1159 E. County Road E, Vadnais Heights, MN 55110 | 2013-02-06 |
| 1639444284 | Rebecca Lynn Blaede | Counselor | 4858 Banning Avenue, White Bear Lake, MN 55110 | 2012-03-15 |
| Find all providers in zip 55110 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356335962 | Ramona Ann Allard-hendren | Nurse Practitioner | 2730 County Road E E, White Bear Lake, MN 55110-4963 | 2005-09-09 |
| 1982259016 | Cassandra Sue Morales | Nurse Practitioner | 2730 County Road E E, White Bear Lake, MN 55110-4963 | 2019-08-06 |
| 1891284568 | Hannah O'leary | Nurse Practitioner | 2730 County Road E E, White Bear Lake, MN 55110-4963 | 2018-05-08 |
| 1629276050 | Monica Beulke | Nurse Practitioner | 2730 County Road E E, White Bear Lake, MN 55110-4963 | 2007-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466368 | Amalia Jo Folland Harvey | Nurse Practitioner | 19883 Evensong Ct, Farmington, MN 55024-8688 | 2020-10-29 |
| 1710586235 | Jackelyn Laura Peterson | Nurse Practitioner | 10101 Bren Rd E Unit 345, Minnetonka, MN 55343-0060 | 2020-10-26 |
| 1578162509 | Mckenzie Mcadaragh | Nurse Practitioner | 10924 Girard Curve, Bloomington, MN 55431 | 2020-10-21 |
| 1861091704 | Morgan Rohl | Nurse Practitioner | 117 12th Ave Nw Apt 2, Rochester, MN 55901-2787 | 2020-10-21 |
| 1063010304 | Kalie R Mccauley | Nurse Practitioner | 11452 Brook Rd Nw, Elk River, MN 55330-8739 | 2020-10-09 |
| 1659978930 | Sarah Jean Mudge | Nurse Practitioner | 350 Harbor Dr, Duluth, MN 55802-2600 | 2020-10-08 |
| 1285231621 | Karlu Dorleh | Nurse Practitioner | 14151 Territorial Rd Unit 212, Maple Grove, MN 55369-5725 | 2020-10-08 |
| 1447857669 | Kimberly Dawn Bursch-tewalt | Nurse Practitioner | 11884 237th Ave Nw, Elk River, MN 55330-8255 | 2020-10-01 |
| 1639786312 | Peter Wahl | Nurse Practitioner | 4652 Lyndale Ave S, Minneapolis, MN 55419-5302 | 2020-09-28 |
| 1568078616 | Joanna Kay Rehm | Nurse Practitioner | 3025 Eagandale Pl Apt 338, Eagan, MN 55121-1236 | 2020-09-23 |
| Find all providers with the same taxonomy | ||||
| City | WHITE BEAR LAKE |
| Zip Code | 55110 |
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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.