DR. JUSTIN ROBERT WIRTH (NPI# 1629687124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629687124 |
Entity Type | Individual |
Full Name | DR. JUSTIN ROBERT WIRTH |
Other Name | DR. JUSTIN ROBERT WIRTH |
Credential | DNP, APRN, PMHNP-BC |
Practice Address |
4801 Veterans Dr # 111 Saint Cloud MN 56303-2015 |
Mailing Address |
15953 47th St Nw Annandale MN 55302-3902 |
Practice Telephone | 3202521670 |
Mailing Telephone | 3202903895 |
Enumeration Date | 2020-07-30 |
Last Update Date | 2020-07-30 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
7559 | MN | Physician Assistants & Advanced Practice Nursing Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1154829042 | Justin Wirth | Counselor | Rebekah Childrens Services, 290 Ioof Ave, Gilroy, CA 95020 | 2018-01-25 |
Street Address |
4801 VETERANS DR # 111 |
City | SAINT CLOUD |
State | MN |
Zip Code | 56303-2015 |
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 | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255976387 | Victoria Sybilla Hadley | Nurse Practitioner | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2019-11-13 |
1215579461 | Merryssa Lynn Wood | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2019-10-09 |
1790334043 | Jeffrey Charles Kessler | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303 | 2019-09-10 |
1508344466 | Andrea Margo Petersen | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2018-08-02 |
1114324829 | Lucille Lyda Hanson | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2014-11-24 |
1982007290 | Brett Tillman | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2014-09-30 |
1104905660 | Kay Ann Keimig | Nurse Practitioner | 4801 Veterans Dr, Saint Cloud, MN 56303-2015 | 2006-11-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285234435 | Hawa Warsame Ali | Nurse Practitioner | 2650 Portland Ave, Minneapolis, MN 55407-1011 | 2020-10-27 |
1962009548 | Emily Ongaga | Nurse Practitioner | 43 10 Parkview Circle, Anoka, MN 55303 | 2020-10-06 |
1811504038 | Rita Jane Giglio | Nurse Practitioner | 201 Stade Ln, Fairmont, MN 56031-3227 | 2020-09-30 |
1568077725 | Linda Mongare | Nurse Practitioner | 3659 Tower Pond Dr, Anoka, MN 55303-8302 | 2020-09-14 |
1366056806 | Associates In Mental Health and Addiction Services. P.l.l.c | Nurse Practitioner | 166 W 3rd St Ste 202, Winona, MN 55987-6591 | 2020-09-02 |
1891308813 | Chelsey Paulson | Nurse Practitioner | 228 Krays Mill Rd, Cold Spring, MN 56320-4563 | 2020-08-28 |
1417560681 | Amy Engle | Nurse Practitioner | 1125 Se 8th Street, Willmar, MN 56201 | 2020-08-28 |
1609488964 | Heather Mantsch | Nurse Practitioner | 1900 Silver Lake Rd Nw Ste 100, New Brighton, MN 55112-1786 | 2020-08-18 |
1326659210 | Monsurat Oluwa-okougbo | Nurse Practitioner | 1565 11th Ave, Newport, MN 55055-1650 | 2020-08-13 |
1336761261 | Mission Mental Health LLC | Nurse Practitioner | 1973 Sloan Pl Ste 50b, Maplewood, MN 55117-2084 | 2020-05-14 |
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.