NICOLE ALTSTATT, CNP — NPI 1982077061 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family in WHITE BEAR LAKE, MN)

CMS-1500 Box 24J / 33a • NPI

1982077061

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LF0000X (CMS 50)

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

Box 32 Service Location & ZIP+4

4786 BANNING AVE, WHITE BEAR LAKE, MN, 55110-3264

✓ 9-Digit EDI 837 ZIP+4 (55110-3264)

Practice Phone & Referral Fax

(612) 579-0597

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1982077061 (NICOLE ALTSTATT, CNP) 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	`1982077061` (NPI-1 Individual Practitioner)
Provider / Legal Name	NICOLE ALTSTATT, CNP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: `363LF0000X` (Nurse Practitioner, Family)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4786 BANNING AVE, WHITE BEAR LAKE, MN, 55110-3264
Practice Telephone / Fax	Tel: (612) 579-0597
Administrative Mailing Address	15830 FARNHAM AVE N, HUGO, MN, 55038-9002
Enumeration & Last Sync	Enumerated: 2015-11-11 \| CMS Record Updated: 2019-02-13

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4786 BANNING AVE, WHITE BEAR LAKE, MN, 55110-3264

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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)

What Does Taxonomy Code 363LF0000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"

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, Family for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NICOLE ALTSTATT, CNP)

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
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: MN \| License: `CNP 4271` \| Primary: Secondary
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: MN \| License: `CNp 4271` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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NICOLE ALTSTATT, CNP (NPI #1982077061)