BRUCE C MCNICKLE (NPI# 1922057694) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922057694 |
| Entity Type | Individual |
| Full Name | BRUCE C MCNICKLE |
| Credential | PHD LP |
| Practice Address |
1900 Centracare Circle Centracare Health Plaza St Cloud MN 56303 |
| Mailing Address |
1406 6th Ave N St Cloud MN 56303 |
| Practice Telephone | 3202294977 |
| Practice Fax Number | 3206567058 |
| Mailing Telephone | 3202512700 |
| Mailing Fax Number | 3206567026 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2008-01-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
LP1975 | MN | Behavioral Health & Social Service Providers |
| Street Address |
1900 CENTRACARE CIRCLE CENTRACARE HEALTH PLAZA |
| City | ST CLOUD |
| State | MN |
| Zip Code | 56303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003815051 | Jennifer J Rogan | Pediatrics | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2005-07-20 |
| 1659694628 | Bethany T. Dingmann | Dietitian, Registered | 1900 Centracare Circle, Suite 2500, St Cloud, MN 56303-5000 | 2010-03-05 |
| 1073708608 | Rachel Wenner Ruzanic | Dermatology | 1900 Centracare Circle, Centracare Clinic- Health Plaza Specialties, St Cloud, MN 56303-5000 | 2007-09-06 |
| 1982737938 | Daniel W Kraft | Internal Medicine | 1900 Centracare Circle, Centracare Clinic Health Plaza Gastroenterology, St Cloud, MN 56303 | 2007-03-13 |
| 1154466209 | Robin C Marushin | Obstetrics & Gynecology | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2007-02-20 |
| 1124173919 | David M Pence | Radiology | 1900 Centracare Circle, St Cloud, MN 56303 | 2007-01-24 |
| 1659425114 | Centracare Clinic | Durable Medical Equipment & Medical Supplies | 1900 Centracare Circle, Centracare Clinic Internal Medicine, St Cloud, MN 56303 | 2007-01-22 |
| 1720155336 | Nelson L Adamson | Radiology | 1900 Centracare Circle, Centracare Clinic Health Plaza Specialties, St Cloud, MN 56303-5000 | 2006-11-29 |
| 1588734214 | Erin Y Scapanski | Physician Assistant | 1900 Centracare Circle, Centracare Clinic, St Cloud, MN 56303 | 2006-11-09 |
| 1639248065 | Donna F Johnson | Psychologist | 1900 Centracare Circle, Centracare Health Plaza, St Cloud, MN 56303 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355275 | Paul Franklin Singh | Psychologist | 150 E Travelers Trl Ste G, Burnsville, MN 55337-6890 | 2020-10-29 |
| 1639779127 | Abdifatah Nuuh | Psychologist | 4204 16th Ave S, Minneapolis, MN 55407-3312 | 2020-10-26 |
| 1134732514 | Colleen Cashen | Psychologist | 1341 Cleveland Ave S, Saint Paul, MN 55116-2653 | 2020-08-26 |
| 1295357440 | Pure Potential Counseling | Psychologist | 18685 Dylan Dr, Farmington, MN 55024-7070 | 2020-05-11 |
| 1871115337 | Melissa Jean King | Psychologist | 205 W 2nd St Ste 437, Duluth, MN 55802-1922 | 2020-05-07 |
| 1841811296 | Kristen Math X | Psychologist | 1603 Pebble Creek Dr, Sartell, MN 56377-4538 | 2020-04-27 |
| 1245859982 | Thomas Allen | Psychologist | 12 Valley View Pl, Mankato, MN 56001-2500 | 2020-04-13 |
| 1033749163 | Neurocalm, LLC | Psychologist | 3153 Hennepin Ave Ste 211, Minneapolis, MN 55408-2620 | 2020-01-16 |
| 1457999500 | Megan Robb | Psychologist | 555 W Broadway Ave Ste 2and3, Forest Lake, MN 55025-1175 | 2019-12-18 |
| 1821635723 | Leadership Coaching Institute LLC | Psychologist | 1264 Garden St, Ogilvie, MN 56358-3520 | 2019-12-10 |
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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.