1700820883 NPI number — NICOLE ANNE BEMMELS CARLSON M.S.P.A.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700820883 NPI number — NICOLE ANNE BEMMELS CARLSON M.S.P.A.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CARLSON

Provider First Name:

NICOLE

Provider Middle Name:

ANNE BEMMELS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.S.P.A.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1700820883

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/26/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6500 EXCELSIOR BLVD.

Provider Second Line Business Mailing Address:

PARK NICOLLET HEART AND VASCULAR CENTER

Provider Business Mailing Address City Name:

ST. LOUIS PARK

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55426

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-624-0123

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

6500 EXCELSIOR

Provider Second Line Business Practice Location Address:

PARK NICOLLET HEART AND VASCULAR CENTER

Provider Business Practice Location Address City Name:

ST. LUOIS PARK

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55426

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-423-9088

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363A00000X , with the licence number:  9899 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 363AM0700X , with the licence number: 9899 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 41995800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 01-06279 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2230947 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 616R8BE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 01-19215 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 132339 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: B018 . This is a "CHAMPUS/TRIWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 916427800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1042013 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP46702 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".