Provider Demographics
NPI:1609824465
Name:MAZE, NOELLE M (RN, MA, C-ANP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:M
Last Name:MAZE
Suffix:
Gender:F
Credentials:RN, MA, C-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:8100 W 78TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2516
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:952-946-9888
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR958958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1012400OtherPREFERRED ONE
MN120003727OtherWEA
MN21R85MAOtherBLUE CROSS/SHIELD
MN0401120OtherSELECT CARE
MN116764OtherUCARE
MN500005086OtherRAILROAD MEDICARE
MNHP19245OtherHEALTHPARTNERS
MN23798OtherAMERICA'S PPO
MN0401120OtherMEDICA
MN108042OtherPATIENT CHOICE
MN947217700Medicaid
MNR96276Medicare UPIN
MN500000787Medicare ID - Type Unspecified