BREEANNA WALETZKO (NPI# 1609252410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609252410 |
| Entity Type | Individual |
| Full Name | BREEANNA WALETZKO |
| Credential | AGPCNP-BC |
| Practice Address |
1406 6th Ave N Saint Cloud MN 56303-1900 |
| Practice Telephone | 3202512700 |
| Mailing Telephone | 3202512700 |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2019-01-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
CNP 4046 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
CNP 4046 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4801 Veterans Dr, Saint Cloud, MN 563032015 | 3202521670 |
| Street Address |
1406 6TH AVE N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-1900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336149939 | Ralph E Fedor | Radiology | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2005-07-26 |
| 1558962399 | Amanda Lee King | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-11-06 |
| 1912512302 | Fadumo Hassan | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-09-11 |
| 1083228092 | Kristin Deneille Hazeman | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1901 | 2020-09-07 |
| 1508477845 | Taylor Dean Olson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-11 |
| 1407467749 | Traci Jo Salveson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-11 |
| 1487264164 | Cameron Charles Hendrickson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-06 |
| 1154931475 | Megan Ann Brown | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-08-01 |
| 1326657255 | Amanda J Dircks | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-07-27 |
| 1003439241 | Mary Elizabeth Amundson | Registered Nurse | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2020-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992341796 | Satchel James Iten | Nurse Practitioner | 1900 Centracare Cir Ste 500, Saint Cloud, MN 56303-5000 | 2019-11-27 |
| 1972067205 | Ingrid Cresencio | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2019-01-31 |
| 1578747085 | Ellen B Ellickson | Nurse Practitioner | 1245 15th St N, Saint Cloud, MN 56303-1802 | 2007-12-19 |
| 1275544348 | Mary Sue Labernik | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2006-08-11 |
| 1649281445 | Kay Iken | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2006-08-10 |
| 1003826421 | Angela Dorothy Moscho | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2006-08-08 |
| 1407863970 | Anne E. Rich | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619587193 | Sadiya Abdirahman Esse | Nurse Practitioner | 1690 Silver Lake Rd Nw, New Brighton, MN 55112-1788 | 2020-08-09 |
| 1881226512 | Abby Marie Zenner | Nurse Practitioner | 1771 Countryside Dr, Shakopee, MN 55379-4451 | 2020-02-11 |
| 1174019038 | Adedayo Temitope Dosumu | Nurse Practitioner | 816 50th Ave Nw, Rochester, MN 55901-6554 | 2018-07-03 |
| 1407223159 | Carla Sue Christenson | Nurse Practitioner | 3400 W. 66th St, Edina, MN 55435 | 2015-08-28 |
| 1538573449 | Rebecca Anne Lenz | Nurse Practitioner | 1172 Randolph Ave Apt 8, Saint Paul, MN 55105-2987 | 2014-06-18 |
| 1083027536 | Mueni C Mualuko | Nurse Practitioner | 2220 Riverside Ave # Ms 26602g, Geriatrics Department Ms 26602g/ 2220 Riverside Ave, Minneapolis, MN 55454-1321 | 2014-06-03 |
| 1659623999 | Joy Laansma | Nurse Practitioner | 3366 Oakdale Avenue North, Suite 551, Robbinsdale, MN 55422-2948 | 2012-10-10 |
| 1720337694 | Zhonghua Xie | Nurse Practitioner | 1202 5th Grant Blvd W, Wabasha, MN 55981-1115 | 2012-09-06 |
| 1487937892 | Jonathan Deforest Olson | Nurse Practitioner | 30 W 22nd St, #204, Minneapolis, MN 55404-2428 | 2011-09-21 |
| 1548577224 | Lorene Ann Gray | Nurse Practitioner | 6465 W Shadow Lake Dr, Lino Lakes, MN 55014-1982 | 2010-09-02 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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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.