Healthcare Provider Details

I. General information

NPI: 1417506411
Provider Name (Legal Business Name): ALLISON SHELDON NOMMENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 COON RAPIDS BLVD NW STE 120
COON RAPIDS MN
55433-4568
US

IV. Provider business mailing address

400 N 1ST ST APT 212
MINNEAPOLIS MN
55401-1336
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-9980
  • Fax:
Mailing address:
  • Phone: 262-490-4537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15289
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: