NICOLE ANDERSON — NPI 1477964336 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health in NORTH BRANCH, MN)

CMS-1500 Box 24J / 33a • NPI

1477964336

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LA2200X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health

Box 32 Service Location & ZIP+4

5366 386TH ST NE, NORTH BRANCH, MN, 55056-5833

✓ 9-Digit EDI 837 ZIP+4 (55056-5833)

Practice Phone & Referral Fax

(651) 674-8353

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1477964336 (NICOLE ANDERSON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1477964336` (NPI-1 Individual Practitioner)
Provider / Legal Name	NICOLE ANDERSON
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health NUCC Code: `363LA2200X` (Nurse Practitioner, Adult Health)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	5366 386TH ST NE, NORTH BRANCH, MN, 55056-5833
Practice Telephone / Fax	Tel: (651) 674-8353
Administrative Mailing Address	9778 PINE SHORES DR, PINE CITY, MN, 55063-4575
Enumeration & Last Sync	Enumerated: 2014-05-14 \| CMS Record Updated: 2014-07-03

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

5366 386TH ST NE, NORTH BRANCH, MN, 55056-5833

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Plain-English Taxonomy & CMS Crosswalk (363LA2200X)

What Does Taxonomy Code 363LA2200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2200X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Adult Health for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NICOLE ANDERSON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`163W00000X` — Registered Nurse Plain English: Licensed & Credentialed Registered Nurse	State: MN \| License: `R1795291` \| Primary: Secondary
`363LA2200X` — Nurse Practitioner, Adult Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Adult Health	State: MN \| License: `AG0614167` \| Primary: Yes (Primary)

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NICOLE ANDERSON (NPI #1477964336)