Basic Information
| Provider Information | |||||||||
| NPI: | 1134156359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAISSON | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 E 28TH ST. | ||||||||
| Address2: | UMPHYSICIANS SMILEY'S CLINIC | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123331986 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 E 28TH ST. | ||||||||
| Address2: | UFP SMILEY'S CLINIC | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123330770 | ||||||||
| FaxNumber: | 6123331986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 44929 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0000X | 44929 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0586313 | 05 | IA | MEDICAID | 171902 | 01 | MN | UCARE | OTHER | 01-19354 | 01 | MN | MEDICA CHOICE & PRIMARY | OTHER | 2298998 | 01 | MN | ARAZ | OTHER | 551T1CH | 01 | MN | BCBS | OTHER | 1034699 | 01 | MN | PREFERRED ONE | OTHER | HP39171 | 01 | MN | HEALTHPARTNERS | OTHER |