HEIDI TYDLACKA (NPI# 1386973428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386973428 |
| Entity Type | Individual |
| Full Name | HEIDI TYDLACKA |
| Practice Address |
1805 Ford Ave N Ste 200 Glencoe MN 55336-1371 |
| Practice Telephone | 3208643185 |
| Practice Fax Number | 3208641484 |
| Mailing Telephone | 3208643185 |
| Mailing Fax Number | 3208641484 |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2009-12-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WC1500X |
Registered Nurse Specialization: Community Health |
R 140309-1 | MN | Nursing Service Providers |
| Street Address |
1805 FORD AVE N STE 200 |
| City | GLENCOE |
| State | MN |
| Zip Code | 55336-1371 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942704895 | Erica L Hertzog | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2018-03-23 |
| 1073935557 | Sadie Ann Jenkins | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2014-01-17 |
| 1770904476 | Megan Irene Piehl | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2013-12-23 |
| 1275964405 | Robin Sikkila | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2013-12-13 |
| 1932430469 | Joanne Alise Bolland | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2010-01-22 |
| 1558691402 | Melani Richter | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2009-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316429160 | Lisa M Thompson | Speech-Language Pathologist | 2105 Hennepin Avenue North, Glencoe, MN 55336 | 2018-08-29 |
| 1609207943 | Sherry Sue Henkelmann | Respite Care | 7768-160th St., Glencoe, MN 55336 | 2013-12-12 |
| 1528277449 | Kelly Jo Higgins | Pharmacist | 2211 11th St. E., Glencoe, MN 55336 | 2007-05-21 |
| 1124180450 | Randy Robert Johnson | Chiropractor | 1706 East Tenth Street, Gauer Chiropractic Clinic, Glencoe, MN 55336 | 2006-12-14 |
| 1790863751 | Merrill D Nelson | Dentist | 1015 Greeley Ave, Glencoe, MN 55336 | 2006-11-01 |
| 1902982481 | Michelle Marie Quale | Registered Nurse | 1805 Hennepin Ave. North, Glencoe Regional Health Services, Glencoe, MN 55336 | 2006-10-27 |
| 1417912122 | Lee Medical Inc | Durable Medical Equipment & Medical Supplies | 1209 Greeley Avenue, Glencoe, MN 55336 | 2006-04-18 |
| 1154319705 | Kristine Leonard Knudten | Family Medicine | 1805 Hennepin Ave North, Glencoe, MN 55336 | 2005-10-07 |
| 1285120477 | Nicole Nash | Registered Nurse | 1805 Hennepin Ave N, Glencoe, MN 55336 | 2018-07-10 |
| 1841640091 | Rachael Stoebe | Hearing Instrument Specialist | 2915 10th St E, Glencoe, MN 55336 | 2016-06-20 |
| Find all providers in zip 55336 | ||||
| Taxonomy Code | 163WC1500X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942704895 | Erica L Hertzog | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2018-03-23 |
| 1487054318 | Barbara Oberlin | Registered Nurse | 1805 Ford Ave N, Suite 200, Glencoe, MN 55336-1363 | 2014-08-28 |
| 1770904476 | Megan Irene Piehl | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2013-12-23 |
| 1740512599 | Lori Goebel | Registered Nurse | 1805 Ford Ave N, Suite 200, Glencoe, MN 55336-1363 | 2010-02-04 |
| 1932430469 | Joanne Alise Bolland | Registered Nurse | 1805 Ford Ave N Ste 200, Glencoe, MN 55336-1371 | 2010-01-22 |
| 1205166535 | Renee Lynn Johnson Kotlarz | Registered Nurse | 1805 Ford Ave N, Suite 200, Glencoe, MN 55336-1363 | 2010-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609359827 | Sarah Jean Riedel | Registered Nurse | 631 Jefferson St N, Wadena, MN 56482-2336 | 2018-09-13 |
| 1770062028 | Laura Patricia Stefanski | Registered Nurse | 10910 Kentucky Ave N, Champlin, MN 55316-3822 | 2018-08-08 |
| 1104276070 | Khadra Mohamed | Registered Nurse | 515 15th Ave S, Apt 251, Minneapolis, MN 55454-1588 | 2016-06-21 |
| 1801257662 | Meghan Zigrida Paquette | Registered Nurse | 6055 161st Street Nw, Cass Lake, MN 56601 | 2016-03-08 |
| 1659736221 | Amanda Jean Dahlseng | Registered Nurse | 809 Elm Street, Suite 1200, Alexandria, MN 56308 | 2015-12-23 |
| 1487099933 | Diane Boyenga | Registered Nurse | 2 Roundwind Rd, Luverne, MN 56156-1300 | 2013-05-09 |
| 1780924811 | Lindsay Prescott | Registered Nurse | 308 S Dekalb St, Redwood Falls, MN 56283-1915 | 2013-02-27 |
| 1952654857 | Annmarie J Suess | Registered Nurse | 105 S 5th St Ste 119h, Olivia, MN 56277-1375 | 2012-10-17 |
| 1659646958 | Diane Shepherd | Registered Nurse | 115 Sixth St. Nw, Suite E, Cass Lake, MN 56601-3061 | 2012-03-20 |
| 1558691238 | Vicki Lynn Roff | Registered Nurse | 6248 Balsam Rd Nw, Bemidji, MN 56601-7728 | 2010-01-03 |
| Find all providers with the same taxonomy | ||||
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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.