Provider Demographics
NPI:1750513750
Name:NIKLAUS, STEPHANIE JO (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JO
Last Name:NIKLAUS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:JO
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3443 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2501
Mailing Address - Country:US
Mailing Address - Phone:612-730-4634
Mailing Address - Fax:
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-520-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2009006856363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health