NICOLE MATHEW (NPI# 1073013322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 125J00000X | Dental Therapist | DT96 | MN | Dental Providers |
| Street Address |
636 BROADWAY ST NE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55413-2164 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 55413 | ||||
| Taxonomy Code | 125J00000X |
| Grouping | Dental Providers |
| Classification | Dental Therapist |
| 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] |
| 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 | ||||
| City | MINNEAPOLIS |
| Zip Code | 55413 |
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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.