DR. STACY WALLIN (NPI# 1104225580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104225580 |
| Entity Type | Individual |
| Full Name | DR. STACY WALLIN |
| Credential | DNP, APRN, NNP-BC |
| Practice Address |
1 Burdick Expy W Minot ND 58701-4406 |
| Practice Telephone | 7018575349 |
| Mailing Telephone | 7018575349 |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LN0000X |
Nurse Practitioner Specialization: Neonatal |
R29613 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1 BURDICK EXPY W |
| City | MINOT |
| State | ND |
| Zip Code | 58701-4406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558346882 | Brian Tin-maung | Anesthesiology | 1 Burdick Expy W, Minot, ND 58701-4406 | 2005-12-09 |
| 1972117927 | Rachel Schaan | Pharmacist | 1 Burdick Expy W, Minot, ND 58701-4406 | 2020-09-06 |
| 1184237471 | Michael Donald Peterson | Pharmacist | 1 Burdick Expy W, Minot, ND 58701-4406 | 2020-08-26 |
| 1760005391 | Kennedi Marie Kautzman | Occupational Therapist | 1 Burdick Expy W, Minot, ND 58701-4406 | 2020-05-18 |
| 1417593781 | Alicia Brianne Paulson | Occupational Therapist | 1 Burdick Expy W, Minot, ND 58701-4406 | 2019-11-21 |
| 1558914267 | Keeley Walker | Nurse Anesthetist, Certified Registered | 1 Burdick Expy W, Minot, ND 58701-4406 | 2019-07-22 |
| 1073171864 | Alicia Flesner | Nurse Practitioner | 1 Burdick Expy W, Minot, ND 58701-4406 | 2019-06-05 |
| 1629636204 | Trinity Health | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1 Burdick Expy W, Minot, ND 58701-4406 | 2019-05-30 |
| 1649764770 | Dwight Remington | Nurse Practitioner | 1 Burdick Expy W, Minot, ND 58701-4406 | 2018-06-21 |
| 1104334564 | Tessa M Hartmann | Nurse Anesthetist, Certified Registered | 1 Burdick Expy W, Minot, ND 58701-4406 | 2018-01-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538767926 | Minot Commission On Aging, Inc | In Home Supportive Care | 21 1st Avenue Se, Minot, ND 58701 | 2020-10-16 |
| 1780207647 | Growing Together Inc | Counselor | 515 19 Ave Sw, Minot, ND 58701 | 2020-05-26 |
| 1144867847 | Sarah Howard | Registered Nurse | 1015 South Broadway, Ste. 2, Minot, ND 58701 | 2019-12-02 |
| 1962973453 | Julia Irene Lakoduk | Speech-Language Pathologist | Bell Elementary, 5901 Us-52, Minot, ND 58701 | 2018-12-10 |
| 1073000469 | Goodman Addiction Services | Counselor | 1809 South Broadway Suite S., Minot, ND 58701 | 2018-04-20 |
| 1811405988 | Mackenzie J Jones Pllc | Chiropractor | 1407 S Broadway Ste 123, Minot, ND 58701 | 2018-01-11 |
| 1265957617 | Cassandra Czerwonka | Behavioral Analyst | 1408 20th Ave Sw, Suite 7, Minot, ND 58701 | 2017-08-07 |
| 1689197493 | Rem North Dakota | Intermediate Care Facility, Mentally Retarded | 1905 2nd Street Se, Suite 1a, Minot, ND 58701 | 2017-07-24 |
| 1558890236 | Timothy J Corrigan | Chiropractor | 1418 S Broadway Ste C, Minot, ND 58701 | 2017-06-07 |
| 1265826036 | Premier Physical Therapy of North Dakota Pllc | Physical Therapist | 1715 South Broadway, Minot, ND 58701 | 2015-03-19 |
| Find all providers in zip 58701 | ||||
| Taxonomy Code | 363LN0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Neonatal |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306299375 | Breanna J Wheeler | Nurse Practitioner | 1 Burdick Expy W, Minot, ND 58701-4406 | 2016-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689284671 | Lindsay Raye Busse | Nurse Practitioner | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-08-04 |
| 1538702485 | Brandi Nichole Ozbun | Nurse Practitioner | 300 N 7th St, Bismarck, ND 58501-4439 | 2019-10-23 |
| 1750866935 | Tracy Hinrichs | Nurse Practitioner | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2018-10-03 |
| 1891179701 | Stephanie Nelson | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2015-07-10 |
| 1598148918 | Rachael Niemeyer | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2015-07-02 |
| 1922496975 | Erica Mccray | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2014-12-29 |
| 1649606609 | Brittany J Keller | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2013-09-23 |
| 1912347949 | Julie Ann Loiland | Nurse Practitioner | 1200 S Columbia Rd - Altru Hospital, Grand Forks, ND 58201 | 2013-07-05 |
| 1619238078 | Melanie A Noonan | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2012-06-01 |
| 1598997199 | Stephanie Nilles | Nurse Practitioner | 737 Broadway N, Fargo, ND 58102-4421 | 2009-08-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.