NICOLE MATHEW


Address: 636 Broadway St Ne, Minneapolis, MN 55413-2164
Phone: 6127461530

NICOLE MATHEW (NPI# 1073013322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1073013322
Entity Type Individual
Full Name NICOLE MATHEW
Credential DT
Practice Address 636 Broadway St Ne
Minneapolis
MN 55413-2164
Practice Telephone 6127461530
Practice Fax Number 6127461531
Mailing Telephone 6127461530
Mailing Fax Number 6127461531
Enumeration Date 2018-02-13
Last Update Date 2018-02-13
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 125J00000X Dental Therapist DT96 MN Dental Providers

Office Location

Street Address 636 BROADWAY ST NE
City MINNEAPOLIS
State MN
Zip Code 55413-2164

Providers in the same location

NPI Name Taxonomy Address Enumeration
1225193741 Azar Hemmaty Dentist 636 Broadway St Ne, Minneapolis, MN 55413-2150 2006-12-26
1568074607 Abdulkadir Egeh Dental Therapist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2020-08-19
1568071140 Alyson Farley Dentist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2020-07-29
1558835652 Sara Ann Nelson Dental Hygienist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2019-01-11
1164902847 Melissa Jo Casper Dental Hygienist 636 Broadway St Ne, Minneapolis, MN 55413-2151 2018-08-21
1356836761 Megha Harenkumar Agrawal Dentist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2018-06-27
1518459072 Sara M Smith Dentist 636 Broadway St Ne, Minneapolis, MN 55413 2018-05-31
1447759261 Vanessa Anderson Dental Hygienist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2018-02-07
1285141515 Sylvia Romosz Dental Hygienist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2018-01-09
1790292035 Tamara Ellingson Dental Hygienist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2018-01-09
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1295372274 Alysia R Schwartz Counselor 2155 E Hennepin Ave, Minneapolis, MN 55413 2019-12-09
1427609304 Lingguang Liu Acupuncturist 2021 East Hennepin Ave, Suite 412, Minneapolis, MN 55413 2019-09-23
1437708617 Dream Home Health Care Inc Home Health 2021 E Hennepin Ave, Ste 190, Minneapolis, MN 55413 2019-09-10
1831746536 Aline Care Case Management 1730 New Brighton Blvd Ste 300, Minneapolis, MN 55413 2019-08-19
1073171534 Relate Nutrition & Therapy Dietitian, Registered 79 13th Ave Ne, Suite 103b, Minneapolis, MN 55413 2019-05-30
1740703461 Emily Rudert Counselor 5407 Excelsior Blvd Suite A, B, & E, St. Louis Park, MN 55413 2017-07-25
1316305485 Capital Transportation LLC Non-emergency Medical Transport (VAN) 34 13th Ave Ne #b004, Minneapolis, MN 55413 2016-02-04
1861819989 Traditionally Healthy Chiropractor 1211 Jackson St Ne, Suite 121, Minneapolis, MN 55413 2014-03-26
1588000871 Aztec's Transportation and Home-care LLC Non-emergency Medical Transport (VAN) 843 Summer St Ne #2, Minneapolis, MN 55413 2013-05-14
1114285418 Best Care Transportation Non-emergency Medical Transport (VAN) 2021 E Hennepin Ave Ste. 187, Minneapolis, MN 55413 2012-04-25
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Taxonomy Information

Taxonomy Code 125J00000X
Grouping Dental Providers
Classification Dental Therapist

Taxonomy Definition

A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations.
Notes: Source: Summarized from Minnesota Statute 150A.105. [7/1/2012: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1003230137 Janelle Jehn Dental Therapist 4342 4th Ave S, Minneapolis, MN 55409-2155 2014-02-10
1568074607 Abdulkadir Egeh Dental Therapist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2020-08-19
1033729033 Annalise Wallerich Dental Therapist 2232 Hennepin Ave, Minneapolis, MN 55405-2737 2020-08-04
1679033252 Sheli Kaye Parkison Dental Therapist 4243 4th Ave S, Minneapolis, MN 55409-2113 2019-03-21
1386146942 Julie Marie Klemond Dental Therapist 2001 Bloomington Ave, Minneapolis, MN 55404-3074 2018-02-28
1134637143 Lucky Vang Dental Therapist 2228 E Lake St, Minneapolis, MN 55407-4321 2018-01-12
1891233748 Jenny Meyers Dental Therapist 4243 4th Ave S, Minneapolis, MN 55409-2113 2017-02-10
1679962708 Verny Martinez Dental Therapist 2232 Hennepin Ave, Minneapolis, MN 55405-2737 2015-01-13
1114315678 Teresa Bushnell Dental Therapist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2015-01-06
1124416789 Trina Courtright Dental Therapist 636 Broadway St Ne, Minneapolis, MN 55413-2164 2015-01-06
Find all providers in MINNEAPOLIS

Competitor

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City MINNEAPOLIS
Zip Code 55413

Improve Information

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Dataset Information

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.

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