MRS. TIA MICHELLE GULLICKSON (NPI# 1992187868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992187868 |
| Entity Type | Individual |
| Full Name | MRS. TIA MICHELLE GULLICKSON |
| Credential | FNP-C |
| Practice Address |
105 International Dr Ste. 126 Red Lake Falls MN 56750-4665 |
| Practice Telephone | 2182534606 |
| Practice Fax Number | 2182534681 |
| Mailing Telephone | 2182534606 |
| Mailing Fax Number | 2182534681 |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2015-06-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
CNP 3937 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
105 INTERNATIONAL DR STE. 126 |
| City | RED LAKE FALLS |
| State | MN |
| Zip Code | 56750-4665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053401984 | Thrifty Drug Stores Inc | Durable Medical Equipment & Medical Supplies | 105 International Dr, Suite 102, Red Lake Falls, MN 56750-4665 | 2006-10-13 |
| 1205263860 | Riverview Clinic | Physician Assistant | 105 International Dr, Red Lake Falls, MN 56750-4665 | 2013-09-27 |
| 1467894337 | Richard Walter Seeger | Pharmacist | 105 International Dr, Red Lake Falls, MN 56750-4665 | 2013-07-22 |
| 1841581212 | Riverview Healthcare Association | Clinic/Center | 105 International Dr, Suite 25, Red Lake Falls, MN 56750-4665 | 2011-04-20 |
| 1942460811 | 1 Body Health and Fitness Pa | Chiropractor | 105 International Dr, Suite 121, Red Lake Falls, MN 56750-4665 | 2008-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073788311 | Hillcrest Senior Living | Skilled Nursing Facility | 311 Broadway Ave Ne, Red Lake Falls, MN 56750 | 2008-04-28 |
| 1295180313 | Lesmeister Dental LLC | Dentist | 105 International Drive, Suite 110, Red Lake Falls, MN 56750-0236 | 2016-04-26 |
| 1710922786 | Patrick C Alcorn | Dentist | 105 International Drive, Suite #6, Red Lake Falls, MN 56750-0236 | 2006-06-16 |
| 1578643318 | Ind School District 630 | Local Education Agency (LEA) | 404 Champagne Ave Sw, Red Lake Falls, MN 56750-0399 | 2006-10-16 |
| 1770704587 | Red Lake Falls Volunteer Ambulance Association | Ambulance | 201 Champagne Ave Sw, Red Lake Falls, MN 56750-4003 | 2007-05-01 |
| 1205064300 | Red Lake County Social Services | Case Management | 125 Edwards Ave Sw, Red Lake Falls, MN 56750-4019 | 2009-06-26 |
| 1093009532 | Jo Lambert | Social Worker | 125 Edwards Ave Sw, Red Lake Falls, MN 56750-4019 | 2011-06-01 |
| 1962515940 | Riverview Healthcare Association | Skilled Nursing Facility | 311 Broadway Ave Ne, Red Lake Falls, MN 56750-4224 | 2006-08-16 |
| 1871682344 | Altru Health System | Clinic/Center | 312 International Dr, Red Lake Falls, MN 56750-4603 | 2006-10-12 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| 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 | RED LAKE FALLS |
| Zip Code | 56750 |
Please comment or provide details below to improve the information on MRS. TIA MICHELLE GULLICKSON.
| 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.