NICOLE MARIE ROACH (NPI# 1902378821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902378821 |
| Entity Type | Individual |
| Full Name | NICOLE MARIE ROACH |
| Credential | PA-C |
| Practice Address |
15300 Grove Cir N Maple Grove MN 55369-4469 |
| Practice Telephone | 7634472507 |
| Mailing Telephone | 2183435081 |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2019-02-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 12900 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275004210 | Nicole Brook Roach | Physical Therapy Assistant | 1720 Vieth Dr, Jefferson City, MO 65109-2056 | 2018-12-17 |
| Street Address |
15300 GROVE CIR N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4469 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326060013 | Grand St Paul Cvs LLC | Pharmacy | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2006-07-24 |
| 1063011021 | Zeleke Belay Goshu | Pharmacist | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2020-10-21 |
| 1942835020 | Lindsay Hawkins | Pharmacist | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2020-03-09 |
| 1205360526 | John S Isenberg | Physician Assistant | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2017-04-13 |
| 1235680836 | Yaria Bangura | Nurse Practitioner | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2016-10-18 |
| 1194110411 | Carly Jordan | Pharmacist | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2015-04-02 |
| 1992102735 | Mark Cool | Pharmacist | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2014-11-21 |
| 1669883757 | Tegan Presley | Physician Assistant | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2014-05-12 |
| 1144653544 | Tekla Jay Krebs | Pharmacist | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2013-08-21 |
| 1982036000 | Brady Michael Paul | Pharmacist | 15300 Grove Cir N, Maple Grove, MN 55369-4469 | 2013-07-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295341055 | Alexandra M Fischer | Physician Assistant | 6256 Juneau Ln N, Maple Grove, MN 55311-4137 | 2020-09-17 |
| 1720608763 | Alexa Olson | Physician Assistant | 9049 Archer Ct N, Maple Grove, MN 55311-1826 | 2020-04-20 |
| 1932754538 | Michaela Rose Patton | Physician Assistant | 17649 93rd Pl N, Maple Grove, MN 55311-4436 | 2019-08-09 |
| 1063894129 | Kristen Marie Finnegan | Physician Assistant | 9855 Hospital Dr # 102a, Maple Grove, MN 55369-4648 | 2015-06-25 |
| 1891070694 | Jennifer L Waite | Physician Assistant | 9825 Hospital Dr Ste 205, Maple Grove, MN 55369-4480 | 2011-10-12 |
| 1851621635 | Charise Michde Mehrkens | Physician Assistant | 9855 Hospital Drive Suite 102 A, North Memorial Urgent Care Maple Grove, Maple Grove, MN 55369 | 2009-12-30 |
| 1457579450 | Cynthia C Cassel | Physician Assistant | 6300 Wedgewood Way, Maple Grove, MN 55311 | 2007-04-23 |
| 1649348426 | Timothy Joseph Montag | Physician Assistant | 9645 Grove Circle North, Ste 200, Maple Grove, MN 55369-4466 | 2006-12-01 |
| 1760434211 | Frederick E Demeuse | Physician Assistant | 6545 E Fish Lake Rd, Maple Grove, MN 55369-6005 | 2006-05-16 |
| 1114528593 | Dana Marie Feia | Physician Assistant | 9555 Upland Ln N, Maple Grove, MN 55369-4485 | 2020-11-03 |
| Find all providers in MAPLE GROVE | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.