Provider Demographics
NPI:1669460077
Name:NORDLAND, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:NORDLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1763
Mailing Address - Country:US
Mailing Address - Phone:952-442-2137
Mailing Address - Fax:952-442-5960
Practice Address - Street 1:2355 STANFORD CT UNIT 701
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4813
Practice Address - Country:US
Practice Address - Phone:239-566-7425
Practice Address - Fax:239-593-3430
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLL726207V00000X
MN19812207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN489583500Medicaid
MN169000204Medicare ID - Type Unspecified
MN489583500Medicaid