JERROL NOLLER MD LTD (NPI# 1821257593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821257593 |
| Entity Type | Organization |
| Organization Name | JERROL NOLLER MD LTD |
| Practice Address |
3863 Coon Rapids Blvd Nw Coon Rapids MN 55433-2518 |
| Mailing Address |
1416 Oakwood Dr Anoka MN 55303-2747 |
| Practice Telephone | 7634338300 |
| Practice Fax Number | 7634338308 |
| Mailing Telephone | 7634338300 |
| Mailing Fax Number | 7634338308 |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |
| Authorized Official Name | DR. JERROL JAY NOLLER (PRESIDENT) |
| Authorized Official Telephone | 7634276897 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
23068 | MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 774888400 | 05 |
| Street Address |
3863 COON RAPIDS BLVD NW |
| City | COON RAPIDS |
| State | MN |
| Zip Code | 55433-2518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245343011 | Jerrol Jay Noller | Internal Medicine | 3863 Coon Rapids Blvd Nw, Coon Rapids, MN 55433-2518 | 2006-08-16 |
| 1760693154 | Bryant R. Beehler, D.o., Ltd. | Clinic/Center | 3863 Coon Rapids Blvd Nw, Coon Rapids, MN 55433-2518 | 2007-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770134793 | Shelley Karee Peterson | Technician | 10311 Bittersweet St Nw, Coon Rapids, MN 55433 | 2019-09-20 |
| 1578122057 | Courtney Gau | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Dr. Nw, Coon Rapids, MN 55433 | 2019-06-10 |
| 1992275606 | Maliki Fofee Kamara | Licensed Practical Nurse | 2451 109th Ave Nw Apt. 1, Coon Rapids, MN 55433 | 2018-11-26 |
| 1992284541 | Sarah Vennes | Massage Therapist | 6400 Flying Cloud Dr, Suite 240, Eden Prairie, MN 55433 | 2018-08-13 |
| 1538646609 | Paige Prince | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Drive Nw, Coon Rapids, MN 55433 | 2018-07-23 |
| 1154828242 | Karin Lea Englund | Dentist | 9145 Springbrook Dr Nw Ste 100, Coon Rapids, MN 55433 | 2018-04-06 |
| 1235642513 | Vista Family Eye Care LLC | Optometrist | 9920 Foley Blvd Nw Ste 120, Coon Rapids, MN 55433 | 2017-11-09 |
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1639531353 | Journi LLC | Nurse Practitioner | 277 Coon Rapids Blvd Suite 308, Coon Rapids, MN 55433 | 2016-03-22 |
| 1821457722 | Honorine Boyce | Licensed Practical Nurse | 2743 111th Ave. Nw, Coon Rapids, MN 55433 | 2016-02-19 |
| Find all providers in zip 55433 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407903248 | Edina Eye Physicians and Surgeons Pa | Clinic/Center | 3777 Coon Rapids Blvd Nw, Suite 100, Coon Rapids, MN 55433 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922576081 | Complex Cares LLC | Clinic/Center | 4700 Lexington Ave N Ste C, Shoreview, MN 55126-5964 | 2018-11-07 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1992196307 | Austin Orthopedics & Sports Medicine | Clinic/Center | 14051 Burnhaven Dr Ste 100, Burnsville, MN 55337-4400 | 2015-02-08 |
| 1831599430 | Medifit Health, LLC | Clinic/Center | 9201 Quaday Ave Ne Ste 203, Otsego, MN 55330-6604 | 2014-09-02 |
| 1437567609 | Aligned Chiropractic Pa | Clinic/Center | 3408 E Lake St, Suite 120, Minneapolis, MN 55406-2175 | 2014-07-31 |
| 1316369911 | New Leaf Medical, Pllc | Clinic/Center | 3622 County Road 101 S, Wayzata, MN 55391-3424 | 2014-01-16 |
| 1861825093 | Active Feet, Foot & Ankle Health Center | Clinic/Center | 10995 Club West Pkwy Ste 300, Blaine, MN 55449-5861 | 2013-08-12 |
| 1841538808 | White Dandelion Chinese Medicine L.L.C. | Clinic/Center | 108 3rd St E, Northfield, MN 55057-2050 | 2013-01-27 |
| 1831409234 | Princeton Chiropractic Clinic LLC | Clinic/Center | 501 4th St S Ste 101, Princeton, MN 55371-4754 | 2010-10-19 |
| 1629252101 | Paula Allenburg, Ltd | Clinic/Center | 2415 Emerson Ave S, Minneapolis, MN 55405-2602 | 2007-12-20 |
| Find all providers with the same taxonomy | ||||
| City | COON RAPIDS |
| Zip Code | 55433 |
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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.