CARISSA R CORNELL (NPI# 1629323605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629323605 |
| Entity Type | Individual |
| Full Name | CARISSA R CORNELL |
| Credential | NP |
| Practice Address |
3345 39th St S Ste 2 Fargo ND 58104 |
| Mailing Address |
5615 Dunbarton Ave Pasco WA 99301-8216 |
| Practice Telephone | 5092221275 |
| Practice Fax Number | 5094913031 |
| Mailing Telephone | 5092221275 |
| Mailing Fax Number | 5094913031 |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2018-07-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | R34040 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3345 39TH ST S STE 2 |
| City | FARGO |
| State | ND |
| Zip Code | 58104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871540435 | Brian Jefferson Dawson | Emergency Medicine | 3345 39th St S Ste 2, Fargo, ND 58104 | 2006-05-28 |
| 1083143580 | Ashley Tebay | Nurse Practitioner | 3345 39th St S Ste 2, Fargo, ND 58104 | 2017-06-08 |
| 1538538707 | Jaclyn Susan Roers Kassen | Nurse Practitioner | 3345 39th St S Ste 2, Fargo, ND 58104 | 2015-09-17 |
| 1487754487 | Jane Louise Sveen | Physician Assistant | 3345 39th St S Ste 2, Fargo, ND 58104 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837347 | Pinnacle Therapy & Wellness, Pllc | Physical Therapist | 4500 36th Ave S Suite 100, Fargo, ND 58104 | 2020-07-02 |
| 1619509858 | Patricia Helen Bathie | Counselor | 4243 Auburn Ave., Fargo, ND 58104 | 2020-02-05 |
| 1346892866 | Elizabeth Olis | Registered Nurse | 2633 55th St. S, Apartment 202, Fargo, ND 58104 | 2019-07-15 |
| 1780247023 | Keith Kirimi Ndege | Physical Therapy Assistant | 5225 23rd Ave South, Fargo, ND 58104 | 2019-04-22 |
| 1346728557 | Ms4 Pllc | Pharmacy | 4476 31st Avenue South, Suite #105, Fargo, ND 58104 | 2018-07-31 |
| 1891286977 | Jessica Rae Majidian | Dentist | 3030 49th St S, Fargo, ND 58104 | 2018-05-23 |
| 1821588500 | Alissa Nichole Larson | Pharmacist | 5675 26th Ave S St. 136a, Fargo, ND 58104 | 2018-05-17 |
| 1790297430 | Northern Lights Dental | Dentist | 4150 19th Ave S, Suite 301, Fargo, ND 58104 | 2017-11-03 |
| 1619406733 | Cobalt Rehabilitation Hospital Fargo LLC | Rehabilitation Hospital | 4671 38th Street S, Fargo, ND 58104 | 2017-06-12 |
| 1790210318 | Homefield Health, LLC | Clinic/Center | 4141 31st Ave S., Ste 102, Fargo, ND 58104 | 2017-04-21 |
| Find all providers in zip 58104 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1437565330 | Christina Dahl | Nurse Practitioner | 1665 43rd St S Ste 102, Fargo, ND 58103-3316 | 2014-07-11 |
| 1003242256 | Wendy M Moore | Nurse Practitioner | 901 28th St S, Fargo, ND 58103 | 2013-09-19 |
| 1043599277 | Rebecca Ann Kiecker | Nurse Practitioner | 1720 South University Drive, Sanford South University, Fargo, ND 58103 | 2011-08-05 |
| 1780832634 | Sarah M Baker | Nurse Practitioner | 3274 51st St S, Fargo, ND 58104 | 2008-09-04 |
| 1932207149 | Carlee N Leininger | Nurse Practitioner | 2301 25th St S Ste A, Fargo, ND 58103-6104 | 2006-09-20 |
| 1780607788 | Casey M Hoover | Nurse Practitioner | Rejuv Medical Aesthetic Clinic, 3301 45th St S, Fargo, ND 58103 | 2006-07-25 |
| 1023030517 | Tina M Lundeen | Nurse Practitioner | 600 4th St S, Fargo, ND 58103-2804 | 2006-07-24 |
| 1992727481 | Melissa R Erdmann | Nurse Practitioner | 827 28th St S, Unit B, Fargo, ND 58103-8727 | 2006-07-24 |
| Find all providers in FARGO | ||||
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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.