NICOLE SHOCKLEY (NPI# 1124569041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124569041 |
| Entity Type | Individual |
| Full Name | NICOLE SHOCKLEY |
| Credential | CNP |
| Practice Address |
4325 Grand Ave Duluth MN 55807-2730 |
| Mailing Address |
1500 N 34th St Ste 200 Superior WI 54880-4477 |
| Practice Telephone | 2187221497 |
| Practice Fax Number | 2187226239 |
| Mailing Telephone | 7153955380 |
| Mailing Fax Number | 7153942682 |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2020-09-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | CNP 4971 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3600 Tower Ave, Superior, WI 548805589 | 7153955380 | 7153942682 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538631692 | Nicole Skye Shockley | Day Training/Habilitation Specialist | 625 Ne Galloway St, Mcminnville, OR 97128-3933 | 2018-12-28 |
| Street Address |
4325 GRAND AVE |
| City | DULUTH |
| State | MN |
| Zip Code | 55807-2730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861484875 | Barbara G Hemenway | Family Medicine | 4325 Grand Ave, Duluth, MN 55807-2730 | 2005-08-16 |
| 1457984783 | Kellie Lynn Murphy | Dental Hygienist | 4325 Grand Ave, Duluth, MN 55807-2730 | 2020-02-14 |
| 1417598079 | Brittany Morgan Hamm | Nurse Practitioner | 4325 Grand Ave, Duluth, MN 55807-2730 | 2019-10-04 |
| 1962997023 | Yin Cao | Dentist | 4325 Grand Ave, Duluth, MN 55807-2730 | 2018-06-29 |
| 1609367895 | Susan Marie Johnson | Licensed Practical Nurse | 4325 Grand Ave, Duluth, MN 55807-2730 | 2018-05-23 |
| 1467993774 | Kristie Hills | Counselor | 4325 Grand Ave, Duluth, MN 55807-2730 | 2017-03-20 |
| 1457714560 | Alecia Radtke | Licensed Practical Nurse | 4325 Grand Ave, Duluth, MN 55807-2730 | 2016-04-05 |
| 1386008449 | Amber Tibbetts | Licensed Practical Nurse | 4325 Grand Ave, Duluth, MN 55807-2730 | 2016-04-05 |
| 1679934012 | Rebecca Ann Peterson | Nurse Practitioner | 4325 Grand Ave, Duluth, MN 55807 | 2016-03-13 |
| 1467813964 | Lisa Ann Robertson | Dental Hygienist | 4325 Grand Ave, Duluth, MN 55807-2730 | 2016-03-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568918126 | Jaime Lynn Mallory | Counselor | 4000 W 9th St., Duluth, MN 55807 | 2016-09-01 |
| 1568817138 | Fathers Rise Together | Community/Behavioral Health | 319 N 22nd Ave West, Duluth, MN 55807 | 2016-05-02 |
| 1558660357 | Melissa June Huray | Counselor | 326 North Central Avenue, Duluth, MN 55807 | 2011-03-18 |
| 1376757682 | Chiropractic Health Center P A | Chiropractor | 215 North Central Ave, Duluth, MN 55807 | 2007-05-09 |
| 1639235914 | Mark Andrew Nelson Albee | Social Worker | 4214 Grand Avenue, Duluth Clinic-west, Duluth, MN 55807 | 2006-12-29 |
| 1851457758 | Northwood Children's Services, Inc. | Counselor | 4000 W 9th St, Duluth, MN 55807 | 2006-12-28 |
| 1326134529 | Jane Patricia Rudd | Family Medicine | 4212 Grand Ave, Duluth, MN 55807 | 2006-10-05 |
| 1548290257 | Kirsten I Bich | Family Medicine | 4212 Grand Ave, Essentia Health West Duluth Clinic, Duluth, MN 55807 | 2006-07-05 |
| 1033140660 | Wendell R Bonner | Family Medicine | 4212 Grand Ave, Duluth, MN 55807 | 2006-07-05 |
| 1225525645 | Mark J Engebretson | Social Worker | 5814 Elinor St, Duluth, MN 55807-1215 | 2018-04-20 |
| Find all providers in zip 55807 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548877723 | Camille Watson-clarke | Nurse Practitioner | 3650 Steve Reynolds Blvd Ste 316, Duluth, GA 30096-4506 | 2020-09-30 |
| 1568089340 | Emily Abernethy | Nurse Practitioner | 1001 E Superior St Ste 401, Duluth, MN 55802-2229 | 2020-06-29 |
| 1588159388 | Marilyne Jones | Nurse Practitioner | 3920 Club Dr Apt 724, Duluth, GA 30096-7101 | 2018-06-25 |
| 1225534977 | Philip Douglas Knese | Nurse Practitioner | 1012 E 2nd St Bldg A, Duluth, MN 55805-2200 | 2018-04-02 |
| 1962811604 | Claire Elena Kap | Nurse Practitioner | Essentia Health Duluth Clnic, 400 East Third Street, Duluth, MN 55805 | 2014-08-06 |
| 1477964559 | Vincentia Asantewah Adjei | Nurse Practitioner | 6340 Sugarloaf Pkwy Ste 200, Duluth, GA 30097-4329 | 2014-05-12 |
| 1346473998 | Patricia A Trachte | Nurse Practitioner | 107 Ksc, Umd Quick Care, Duluth, MN 55812 | 2009-08-31 |
| 1992864821 | The College of St. Scholastica | Nurse Practitioner | Css 1200 Kenwood Avenue, Student Health Service, Duluth, MN 55811 | 2006-12-06 |
| 1508979253 | New Day Health | Nurse Practitioner | 1180 88th Ave. West, Suite 2, Duluth, MN 55808 | 2006-08-16 |
| 1770558751 | Thelma Berry Cummings | Nurse Practitioner | 3650 Steve Reynolds Boulevard, Kp Medical Center At Gwinnett, Duluth, GA 30086 | 2006-02-22 |
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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.