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MADELINE NICOLE DETRA
NPI 1992634885
General Practice in Anoka, MN

Active since May 16, 2026
2621 GREENHAVEN RD, ANOKA, MN 55303(763) 421-5540 Get Directions Write a Review

NPPES record last updated: May 16, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Madeline Nicole Detra NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADELINE NICOLE DETRA (NPI 1992634885) is an individual general practice provider in Anoka, Minnesota, licensed in Minnesota (1346244274) and active in the NPI registry since May 2026.

NPPES Registry Identity

NPI1992634885
Entity TypeIndividualFemale
Primary Taxonomy208D00000X
Provider Legal NameMADELINE NICOLE DETRA
Location Address2621 GREENHAVEN RDAnoka, MN 55303-5566
Mailing Address2621 Greenhaven RdAnoka, MN 55303-5566 · (763) 421-5540
Phone(763) 421-5540
Sole ProprietorNo
Enumeration DateMay 16, 2026
NPPES CertifiedMay 16, 2026
✔ NPI 1992634885 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in MN · 1346244274
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
2621 GREENHAVEN RD, Anoka, MN 55303
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Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRYSTIN MELISSA HOLODY M.D.
Family Medicine
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4488
MEATTA ELLEN GAYPIA APRN, CNP
Nurse Practitioner
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4488
KAYLA LOUISE PUENT CNM
Advanced Practice Midwife
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4488
HIBO B ABUD
Pharmacist
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 421-5540
MRS. JULIE ANN BOHLMAN PA-C
Physician Assistant
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4400
MS. DAVIKA SERENE ANNIS PA-C
Physician Assistant
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4688
ABBY ANDERSON PHYSICIAN ASSISTANT
Physician Assistant
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4400
GROUP HEALTH PLAN, INC.
Clinic/Center (Pain)
2621 GREENHAVEN RD
ANOKA, MN 55303
Anoka County (763) 587-4488

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Madeline Detra's NPI number?

The NPI number for Madeline Detra is 1992634885. It was assigned to this individual provider in the NPPES registry on May 16, 2026.

Where is Madeline Detra located?

Madeline Detra practices at 2621 Greenhaven Rd, Anoka, MN 55303. The listed phone number is (763) 421-5540.

What is Madeline Detra's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Madeline Detra was last updated on May 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.