| Gillette Children's Professional Services | |
|
200 East University Ave St. Paul MN 55101 | |
| (651) 291-2848 | |
| (651) 325-2250 |
| Full Name | Gillette Children's Professional Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 East University Ave, St. Paul, Minnesota |
| Authorized Official Name and Position | Patrick Nolan (CFO) |
| Authorized Official Contact | 6513123105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gillette Children's Professional Services 200 East University Ave St. Paul MN 55101 Ph: (651) 291-2848 | Gillette Children's Professional Services 200 East University Ave St. Paul MN 55101 Ph: (651) 291-2848 |
| NPI Number | 1225119175 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 12/13/2019 |
| Medicare PECOS PAC ID | 0547169211 |
|---|---|
| Medicare Enrollment ID | O20040503000485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225119175 | NPI | - | NPPES |
| 0578435 | Medicaid | IA | |
| 1225119175 | Medicaid | MN | |
| 32809900 | Medicaid | WI | |
| 29006TE | Other | MN | BLUE CROSS & BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | David B Gremmels |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1508813452 PECOS PAC ID: 8820992357 Enrollment ID: I20031125000578 |
| Provider Name | Ralph J Faville |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689754590 PECOS PAC ID: 9133028921 Enrollment ID: I20031231000072 |
| Provider Name | Deborah C Bohn |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1902883192 PECOS PAC ID: 6709789043 Enrollment ID: I20040202000628 |
| Provider Name | Mark T Dahl |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1508862194 PECOS PAC ID: 8426943911 Enrollment ID: I20040216000117 |
| Provider Name | David A Burton |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1518906007 PECOS PAC ID: 0749176410 Enrollment ID: I20040227000677 |
| Provider Name | Justin M Kirven |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093778524 PECOS PAC ID: 1052304045 Enrollment ID: I20040406000526 |
| Provider Name | Jennifer Wilhelmy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164504767 PECOS PAC ID: 2163339987 Enrollment ID: I20040525000555 |
| Provider Name | Julie M Boman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427022110 PECOS PAC ID: 2365424827 Enrollment ID: I20040607001139 |
| Provider Name | Nancy J Mendelsohn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033106091 PECOS PAC ID: 2062492069 Enrollment ID: I20040721000819 |
| Provider Name | Anne E Bendel |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1508830092 PECOS PAC ID: 5991776254 Enrollment ID: I20040802001299 |
| Provider Name | Deanna Jo Diebold |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235166737 PECOS PAC ID: 5890766513 Enrollment ID: I20040804001563 |
| Provider Name | Michael Shreve |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700887312 PECOS PAC ID: 0446226567 Enrollment ID: I20040909001046 |
| Provider Name | Paul T Kubic |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1275534042 PECOS PAC ID: 2163498106 Enrollment ID: I20040909001149 |
| Provider Name | Lee Y Schuh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699844167 PECOS PAC ID: 7719972363 Enrollment ID: I20041012000258 |
| Provider Name | Kevin J Sheridan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326134214 PECOS PAC ID: 1456315613 Enrollment ID: I20041117000315 |
| Provider Name | Christopher S Bowron |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174695704 PECOS PAC ID: 6901855113 Enrollment ID: I20050114000222 |
| Provider Name | Galen Breningstall |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437185394 PECOS PAC ID: 4880649607 Enrollment ID: I20050315000434 |
| Provider Name | Robert J Wagner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356301998 PECOS PAC ID: 5294782819 Enrollment ID: I20050406000356 |
| Provider Name | William B Wheeler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1417959362 PECOS PAC ID: 9436125556 Enrollment ID: I20050420001226 |
| Provider Name | Ramalingam Arumugam |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265404057 PECOS PAC ID: 8325036635 Enrollment ID: I20050421000864 |
| Provider Name | Kimberly R Cochran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336109404 PECOS PAC ID: 5799725453 Enrollment ID: I20050512000140 |
| Provider Name | Kenneth K Maslonka |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1639170418 PECOS PAC ID: 0547236663 Enrollment ID: I20050601000732 |
| Provider Name | Eric T Becken |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1578509832 PECOS PAC ID: 1658314141 Enrollment ID: I20050606000836 |
| Provider Name | Denise Leighty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366524969 PECOS PAC ID: 6800831785 Enrollment ID: I20050621001233 |
| Provider Name | Peter J Melchert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699735837 PECOS PAC ID: 3678519626 Enrollment ID: I20050630000206 |
| Provider Name | Arthur A Beisang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760562466 PECOS PAC ID: 1759317969 Enrollment ID: I20050711000445 |
| Provider Name | David P Tetzlaff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245290329 PECOS PAC ID: 1658307442 Enrollment ID: I20050713000290 |
| Provider Name | Saiyid J Hasan |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1356317705 PECOS PAC ID: 6204865900 Enrollment ID: I20050811000802 |
| Provider Name | Marcia E Ward |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1629150370 PECOS PAC ID: 4082648167 Enrollment ID: I20050920000188 |
| Provider Name | Ann E Van Heest |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1194833376 PECOS PAC ID: 7113942335 Enrollment ID: I20051006000879 |
| Provider Name | Kelly Marie Bolf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629004247 PECOS PAC ID: 8527010743 Enrollment ID: I20051012000914 |
| Provider Name | Jill S Gettings |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1720170822 PECOS PAC ID: 9133189079 Enrollment ID: I20051102000343 |
| Provider Name | Christopher J French |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1427029073 PECOS PAC ID: 4486672573 Enrollment ID: I20051107001143 |
| Provider Name | Nancy C Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952483604 PECOS PAC ID: 9537188081 Enrollment ID: I20051115000206 |
| Provider Name | Michelle S Kennedy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1023080751 PECOS PAC ID: 4981692266 Enrollment ID: I20051116000974 |
| Provider Name | Judith L Zier |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174525059 PECOS PAC ID: 9335115450 Enrollment ID: I20060116000157 |
| Provider Name | Mary K Wilkin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831191782 PECOS PAC ID: 5799751814 Enrollment ID: I20060116000177 |
| Provider Name | Steven D Baisch |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265432769 PECOS PAC ID: 1052335130 Enrollment ID: I20060117000016 |
| Provider Name | Jennifer C Maytum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629150248 PECOS PAC ID: 0840205548 Enrollment ID: I20060216000490 |
| Provider Name | Sean Patrick Elliott |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1861435943 PECOS PAC ID: 5698715647 Enrollment ID: I20060823000293 |
| Provider Name | Amanda R Seeley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386725901 PECOS PAC ID: 0941207039 Enrollment ID: I20061102000445 |
| Provider Name | Susan L Kearney |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1154375061 PECOS PAC ID: 8628077096 Enrollment ID: I20061212000515 |
| Provider Name | Patrick C Graupman |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1639245822 PECOS PAC ID: 1759359243 Enrollment ID: I20070125000219 |
| Provider Name | John J Garcia |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1275585861 PECOS PAC ID: 1456353655 Enrollment ID: I20070131000531 |
| Provider Name | Michael B Ainslie |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1114902186 PECOS PAC ID: 6103828488 Enrollment ID: I20070215000672 |
| Provider Name | Ellen B Snoxell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285859157 PECOS PAC ID: 1052417862 Enrollment ID: I20070510000262 |
| Provider Name | Sundeep Arora |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770649626 PECOS PAC ID: 5890880397 Enrollment ID: I20070928000148 |
| Provider Name | Daniel A Saltzman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1295818789 PECOS PAC ID: 9335238831 Enrollment ID: I20071207000234 |
| Provider Name | Erin Tentis Berglund |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295755718 PECOS PAC ID: 2365533866 Enrollment ID: I20071217000387 |
| Provider Name | Gretchen E Weatherly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982621926 PECOS PAC ID: 5890885396 Enrollment ID: I20071220000638 |
| Provider Name | Jesse L Hennum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720132319 PECOS PAC ID: 9638259864 Enrollment ID: I20071231000153 |
| Provider Name | Supreet Deshpande |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1912185398 PECOS PAC ID: 1355425430 Enrollment ID: I20080227000866 |
| Provider Name | Tom F Novacheck |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1831133347 PECOS PAC ID: 8022015833 Enrollment ID: I20080418000326 |
| Provider Name | Deana Michelle Thomasson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093991499 PECOS PAC ID: 8527146174 Enrollment ID: I20080422000670 |
| Provider Name | Micah P Niermann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639213994 PECOS PAC ID: 5890866768 Enrollment ID: I20080619000758 |
| Provider Name | Mark H Eikenberry |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1265405120 PECOS PAC ID: 5092818880 Enrollment ID: I20080627000319 |
| Provider Name | Robert D Acton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1992749584 PECOS PAC ID: 0042383291 Enrollment ID: I20080721000623 |
| Provider Name | Jill M Root |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134382591 PECOS PAC ID: 1052488046 Enrollment ID: I20080917000046 |
| Provider Name | Brooke M Moore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568662195 PECOS PAC ID: 9234206269 Enrollment ID: I20080917000462 |
| Provider Name | Sarah A Anderson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1700935517 PECOS PAC ID: 0840399184 Enrollment ID: I20080923000776 |
| Provider Name | Christina L Mikesell |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1578756045 PECOS PAC ID: 5890863369 Enrollment ID: I20081010000268 |
| Provider Name | Linda E Krach |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1255361093 PECOS PAC ID: 1355348160 Enrollment ID: I20081030000329 |
| Provider Name | Cathleen M Rock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386723245 PECOS PAC ID: 2860557196 Enrollment ID: I20090219000444 |
| Provider Name | Janelle Pasch-berglund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588829295 PECOS PAC ID: 0840356416 Enrollment ID: I20090305000595 |
| Provider Name | Marshall H Taniguchi |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1205863669 PECOS PAC ID: 3072510882 Enrollment ID: I20090312000644 |
| Provider Name | Cynthia M Huntimer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366492696 PECOS PAC ID: 3971650003 Enrollment ID: I20090407000492 |
| Provider Name | Nissa I Erickson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831140201 PECOS PAC ID: 8224041710 Enrollment ID: I20090422000549 |
| Provider Name | Mark E Gormley |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1558392068 PECOS PAC ID: 6305834078 Enrollment ID: I20090422000646 |
| Provider Name | Michael P Pryor |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1346241999 PECOS PAC ID: 7719953835 Enrollment ID: I20090519000348 |
| Provider Name | Steven E Koop |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1144262320 PECOS PAC ID: 8527056217 Enrollment ID: I20090605000369 |
| Provider Name | Kevin R Walker |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1598701898 PECOS PAC ID: 4082602784 Enrollment ID: I20090623000130 |
| Provider Name | Kris Ann P Schultz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437350725 PECOS PAC ID: 0143371518 Enrollment ID: I20090624000521 |
| Provider Name | Jeffrey E Nowak |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972710143 PECOS PAC ID: 4385736172 Enrollment ID: I20090722000296 |
| Provider Name | Lee E Rivard |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003871229 PECOS PAC ID: 6901950278 Enrollment ID: I20090820000663 |
| Provider Name | Yoav H Messinger |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1063482388 PECOS PAC ID: 2163577479 Enrollment ID: I20090909000486 |
| Provider Name | Timothy A Wood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760696900 PECOS PAC ID: 9335285162 Enrollment ID: I20091008000596 |
| Provider Name | Jean C Stansbury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235211848 PECOS PAC ID: 5092853226 Enrollment ID: I20091110000055 |
| Provider Name | Keith L Cavanaugh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1497830145 PECOS PAC ID: 8426955592 Enrollment ID: I20091118000228 |
| Provider Name | Joseph H Perra |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1326081514 PECOS PAC ID: 0941107783 Enrollment ID: I20100205000603 |
| Provider Name | Deborah S Quanbeck |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1639114424 PECOS PAC ID: 8921005737 Enrollment ID: I20100210000542 |
| Provider Name | Stephen B Sundberg |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1396781696 PECOS PAC ID: 5294732004 Enrollment ID: I20100210000582 |
| Provider Name | Victor Stuart Cox |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1295771558 PECOS PAC ID: 3577512581 Enrollment ID: I20100216001025 |
| Provider Name | Deanna L Dickens |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861413502 PECOS PAC ID: 4082740063 Enrollment ID: I20100329001029 |
| Provider Name | Patricia S Akers |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1497072680 PECOS PAC ID: 6608902150 Enrollment ID: I20100413000062 |
| Provider Name | Benhoor Soumekh |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1932192457 PECOS PAC ID: 6901825140 Enrollment ID: I20100504000378 |
| Provider Name | Bazak Sharon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407099054 PECOS PAC ID: 6406988856 Enrollment ID: I20100720000808 |
| Provider Name | Erik J Mikkelsen |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1467658989 PECOS PAC ID: 8921196304 Enrollment ID: I20100805000620 |
| Provider Name | Martha M Mcgrory |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548598808 PECOS PAC ID: 8729102777 Enrollment ID: I20100828000045 |
| Provider Name | Katherine E Buhrke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356679344 PECOS PAC ID: 7012100555 Enrollment ID: I20101018000234 |
| Provider Name | Stephen P England |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1114968534 PECOS PAC ID: 4880682558 Enrollment ID: I20101115000191 |
| Provider Name | Tenner J Guillaume |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1215133129 PECOS PAC ID: 6800083536 Enrollment ID: I20101207001369 |
| Provider Name | Michael T Healy |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1861672628 PECOS PAC ID: 4688863616 Enrollment ID: I20110106000645 |
| Provider Name | Martin S Lacey |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1821064288 PECOS PAC ID: 0345201182 Enrollment ID: I20110118001342 |
| Provider Name | Didima C Mon-sprehe |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1144268566 PECOS PAC ID: 8325042773 Enrollment ID: I20110128000569 |
| Provider Name | Marko Vezmar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1740599513 PECOS PAC ID: 4284814682 Enrollment ID: I20110202000022 |
| Provider Name | Nicole Jw Doonan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134318488 PECOS PAC ID: 4284815440 Enrollment ID: I20110221000796 |
| Provider Name | Angela M Drummond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700194479 PECOS PAC ID: 0840471728 Enrollment ID: I20110224001007 |
| Provider Name | Christopher D Carter |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1346430592 PECOS PAC ID: 2860676673 Enrollment ID: I20110401000615 |
| Provider Name | Cynthia J Brady |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184625931 PECOS PAC ID: 9931383353 Enrollment ID: I20110409000041 |
| Provider Name | Sarah A Hackworthy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851696082 PECOS PAC ID: 4284818303 Enrollment ID: I20110413000743 |
| Provider Name | Jenna R Katorski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336456656 PECOS PAC ID: 2860678380 Enrollment ID: I20110518000503 |
| Provider Name | Michael R Sprehe |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1528011533 PECOS PAC ID: 2466427638 Enrollment ID: I20110826000493 |
| Provider Name | Catherine M Larson-nath |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457524902 PECOS PAC ID: 4284804956 Enrollment ID: I20110907001317 |
| Provider Name | Marc Tompkins |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1326195454 PECOS PAC ID: 1254482540 Enrollment ID: I20110914000781 |
| Provider Name | Debbie K Song |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1881717973 PECOS PAC ID: 2264604842 Enrollment ID: I20111003000498 |
| Provider Name | Walter H Truong |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669664629 PECOS PAC ID: 7810160223 Enrollment ID: I20111031000757 |
| Provider Name | Elizabeth W Bizier |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1497782718 PECOS PAC ID: 4385664416 Enrollment ID: I20111031000772 |
| Provider Name | Jennifer C Laine |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1871798751 PECOS PAC ID: 2062685340 Enrollment ID: I20111102000109 |
| Provider Name | Alonso Carrasco |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1710299706 PECOS PAC ID: 4981877057 Enrollment ID: I20111105000093 |
| Provider Name | Katherine F Jillson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255629416 PECOS PAC ID: 4183897275 Enrollment ID: I20111107000215 |
| Provider Name | Alison N Schiffern |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1821276668 PECOS PAC ID: 4082888011 Enrollment ID: I20111130000856 |
| Provider Name | Peter D Kim |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1336381185 PECOS PAC ID: 5496887465 Enrollment ID: I20111222000431 |
| Provider Name | Alaina M Laine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174802896 PECOS PAC ID: 6406022094 Enrollment ID: I20120103000609 |
| Provider Name | Angela M Sinner Begnaud |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1447485321 PECOS PAC ID: 7416123021 Enrollment ID: I20120103000715 |
| Provider Name | Heidi A Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366725020 PECOS PAC ID: 0648447763 Enrollment ID: I20120112000600 |
| Provider Name | Megan Marie Hilden Rondeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679856363 PECOS PAC ID: 5991972747 Enrollment ID: I20120118000598 |
| Provider Name | Heather A Naylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134499783 PECOS PAC ID: 8123286069 Enrollment ID: I20120222001032 |
| Provider Name | Timothy J Feyma |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1467561464 PECOS PAC ID: 0547429573 Enrollment ID: I20120312000591 |
| Provider Name | Bradley Jay Segura |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1649390378 PECOS PAC ID: 1052465036 Enrollment ID: I20120313000503 |
| Provider Name | Adam P Foss |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447576392 PECOS PAC ID: 8729242532 Enrollment ID: I20120607000098 |
| Provider Name | Chris P Yang |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1588714463 PECOS PAC ID: 3476614082 Enrollment ID: I20120716000511 |
| Provider Name | Mark G Bartlett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134162118 PECOS PAC ID: 0244217487 Enrollment ID: I20120821000777 |
| Provider Name | Andrew E Schneider |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1942596820 PECOS PAC ID: 4486802428 Enrollment ID: I20120917000134 |
| Provider Name | James Steven Mccabe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538395660 PECOS PAC ID: 6103074158 Enrollment ID: I20120917000259 |
| Provider Name | Erin Marie Kuisle Novak |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447450549 PECOS PAC ID: 0749468445 Enrollment ID: I20120918000140 |
| Provider Name | Elizabeth A. Reed |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508006693 PECOS PAC ID: 2567610371 Enrollment ID: I20120920000488 |
| Provider Name | Tiffany B Cobb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750648531 PECOS PAC ID: 7517116544 Enrollment ID: I20121005000347 |
| Provider Name | Alberto Orioles |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053581876 PECOS PAC ID: 5193977700 Enrollment ID: I20121205000579 |
| Provider Name | Nanette Aldahondo |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1346436417 PECOS PAC ID: 1254584402 Enrollment ID: I20130121000217 |
| Provider Name | Krissa A Jefferis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093052029 PECOS PAC ID: 5890933279 Enrollment ID: I20130523000600 |
| Provider Name | Amy T Moeller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1578706610 PECOS PAC ID: 5496902561 Enrollment ID: I20130813000933 |
| Provider Name | Anna Marie Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356783252 PECOS PAC ID: 7012141260 Enrollment ID: I20131002000158 |
| Provider Name | Benjamin J Novak |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1750599064 PECOS PAC ID: 9032343686 Enrollment ID: I20131014001775 |
| Provider Name | Julie A Mills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306144159 PECOS PAC ID: 0143458570 Enrollment ID: I20140110000827 |
| Provider Name | Amy H Hou |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1508903857 PECOS PAC ID: 3173752607 Enrollment ID: I20140204000652 |
| Provider Name | Erin Wise |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255533576 PECOS PAC ID: 7911071147 Enrollment ID: I20140220000314 |
| Provider Name | Randal C Richardson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740397538 PECOS PAC ID: 2961574322 Enrollment ID: I20140325000680 |
| Provider Name | Kathryn Lindstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144642893 PECOS PAC ID: 8628201431 Enrollment ID: I20140501001777 |
| Provider Name | Erik Christopher Brockman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730348319 PECOS PAC ID: 3577701739 Enrollment ID: I20140507001999 |
| Provider Name | Marcelo P Vargas |
|---|---|
| Provider Type | Practitioner - Medical Genetics And Genomics |
| Provider Identifiers | NPI Number: 1114185154 PECOS PAC ID: 6406007954 Enrollment ID: I20140702000543 |
| Provider Name | Jamie K Flohr |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1144451691 PECOS PAC ID: 9830316165 Enrollment ID: I20140811001969 |
| Provider Name | Christopher Patrick Brown |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629360144 PECOS PAC ID: 2769652197 Enrollment ID: I20140930001654 |
| Provider Name | Vikas Bhambhani |
|---|---|
| Provider Type | Practitioner - Medical Genetics And Genomics |
| Provider Identifiers | NPI Number: 1932429917 PECOS PAC ID: 8426279449 Enrollment ID: I20141016000826 |
| Provider Name | Angela Tridgell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467646919 PECOS PAC ID: 9436371812 Enrollment ID: I20141120000025 |
| Provider Name | Meagan Crary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811254022 PECOS PAC ID: 9335395458 Enrollment ID: I20141209000351 |
| Provider Name | Todd J Dalberg |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1598949927 PECOS PAC ID: 7214182898 Enrollment ID: I20141224001044 |
| Provider Name | Laurie Jo Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679551329 PECOS PAC ID: 9335303163 Enrollment ID: I20150207000125 |
| Provider Name | Erica E Eisenman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891193454 PECOS PAC ID: 0042535106 Enrollment ID: I20150212000087 |
| Provider Name | Anne Gregerson Griffiths |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205083995 PECOS PAC ID: 3678898343 Enrollment ID: I20150221000303 |
| Provider Name | Kelsey M Everson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649611633 PECOS PAC ID: 4486974458 Enrollment ID: I20150515000547 |
| Provider Name | Micah A Berman |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1972747871 PECOS PAC ID: 5799096012 Enrollment ID: I20150612000958 |
| Provider Name | Stephanie A Fritch Lilla |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1275707937 PECOS PAC ID: 2163735127 Enrollment ID: I20150720002113 |
| Provider Name | Lacy D Schwarze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164714911 PECOS PAC ID: 3476866179 Enrollment ID: I20150724010178 |
| Provider Name | Nandini Kataria |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1326306309 PECOS PAC ID: 9830403948 Enrollment ID: I20150803002822 |
| Provider Name | Eduardo J Colom Beauchamp |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1093020950 PECOS PAC ID: 0143535518 Enrollment ID: I20150813010735 |
| Provider Name | Katie H Willihnganz Lawson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720255656 PECOS PAC ID: 0547481566 Enrollment ID: I20151016001834 |
| Provider Name | Megan E Moffatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952680944 PECOS PAC ID: 5395055057 Enrollment ID: I20151109001316 |
| Provider Name | Yosef Wexler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679864201 PECOS PAC ID: 2668772385 Enrollment ID: I20151202002763 |
| Provider Name | Amanda R Woodhull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881067296 PECOS PAC ID: 3870893282 Enrollment ID: I20151207002251 |
| Provider Name | Laura C Tillman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427475706 PECOS PAC ID: 3072814052 Enrollment ID: I20151216001222 |
| Provider Name | Emily Elaine Vanheel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750753604 PECOS PAC ID: 8224339023 Enrollment ID: I20151221002095 |
| Provider Name | Andrew G Georgiadis |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1407084981 PECOS PAC ID: 1557593654 Enrollment ID: I20151230001868 |
| Provider Name | Ann L Schminski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215339510 PECOS PAC ID: 4688971476 Enrollment ID: I20160322001367 |
| Provider Name | Trenton Charles Cooper |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1043539422 PECOS PAC ID: 0941504369 Enrollment ID: I20160817003334 |
| Provider Name | Aaron Tan |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1598056525 PECOS PAC ID: 9234309725 Enrollment ID: I20160823000215 |
| Provider Name | Elise A Albares |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528411105 PECOS PAC ID: 6709164866 Enrollment ID: I20161025002270 |
| Provider Name | Madeleine M Gagnon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659515039 PECOS PAC ID: 0941459705 Enrollment ID: I20161027001203 |
| Provider Name | Daniela Zgherea |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1184818718 PECOS PAC ID: 4385888106 Enrollment ID: I20161101002725 |
| Provider Name | Amy Ashley Authement |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1437478179 PECOS PAC ID: 9234434184 Enrollment ID: I20161110001500 |
| Provider Name | Mindy M Ostrowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952608341 PECOS PAC ID: 2769761345 Enrollment ID: I20161123000394 |
| Provider Name | Susanna R Hunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841742533 PECOS PAC ID: 0143501270 Enrollment ID: I20170104001827 |
| Provider Name | Emily Marie Schaaf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013141738 PECOS PAC ID: 8921303025 Enrollment ID: I20170118000286 |
| Provider Name | Teresa A Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831271444 PECOS PAC ID: 1951687532 Enrollment ID: I20170413002133 |
| Provider Name | Lauren C Rakes |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1699090068 PECOS PAC ID: 4880828607 Enrollment ID: I20170705000617 |
| Provider Name | Daniel J Beissel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1689808057 PECOS PAC ID: 4486949237 Enrollment ID: I20170713002499 |
| Provider Name | Spencer Pruitt |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1386964062 PECOS PAC ID: 1658518287 Enrollment ID: I20170719002843 |
| Provider Name | Laura E Norton |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1831307891 PECOS PAC ID: 3173791001 Enrollment ID: I20170724003317 |
| Provider Name | Katherine E Kruse |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1225340565 PECOS PAC ID: 6901181098 Enrollment ID: I20170816001254 |
| Provider Name | Magdalena Ann Kappelman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447694674 PECOS PAC ID: 2668777822 Enrollment ID: I20170817004174 |
| Provider Name | Daniel J Miller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1285926212 PECOS PAC ID: 2466725957 Enrollment ID: I20170905002364 |
| Provider Name | Megan P Lambert |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1619134178 PECOS PAC ID: 9739352675 Enrollment ID: I20170915000001 |
| Provider Name | Connie N Taylor |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1992016562 PECOS PAC ID: 3476869959 Enrollment ID: I20170920000742 |
| Provider Name | Nasreen S Quadri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992182158 PECOS PAC ID: 3678877719 Enrollment ID: I20171009002310 |
| Provider Name | Shawn C Wedlund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922510007 PECOS PAC ID: 2860759487 Enrollment ID: I20171206001254 |
| Provider Name | Rebecca D Pilarzyk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447760087 PECOS PAC ID: 0143589465 Enrollment ID: I20180112001544 |
| Provider Name | Joseph J Pariser |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1437445087 PECOS PAC ID: 9032411939 Enrollment ID: I20180213002132 |
| Provider Name | Brigid A Packer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194194027 PECOS PAC ID: 9133429574 Enrollment ID: I20180221000773 |
| Provider Name | Bradford J Chu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1952628620 PECOS PAC ID: 5799046710 Enrollment ID: I20180307001376 |
| Provider Name | Ketzela J Marsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568789006 PECOS PAC ID: 2062717176 Enrollment ID: I20180418001530 |
| Provider Name | R Erik Edens |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568552065 PECOS PAC ID: 6800869355 Enrollment ID: I20180511001442 |
| Provider Name | Tori L Bahr |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790195923 PECOS PAC ID: 7618272451 Enrollment ID: I20180710000205 |
| Provider Name | Erin L Flynn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1447525514 PECOS PAC ID: 9830489541 Enrollment ID: I20180718000039 |
| Provider Name | Ruth Joy Barta |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1891063590 PECOS PAC ID: 6608172747 Enrollment ID: I20180731001414 |
| Provider Name | Matthew Chase Severson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1164956413 PECOS PAC ID: 4981976180 Enrollment ID: I20180802000549 |
| Provider Name | Joanna M Lowisz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285992354 PECOS PAC ID: 3274839584 Enrollment ID: I20180810001993 |
| Provider Name | Alicia Marie Teagarden |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407148356 PECOS PAC ID: 8325286107 Enrollment ID: I20180810002807 |
| Provider Name | Caitlin A Lingbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336642131 PECOS PAC ID: 7113276544 Enrollment ID: I20180818000008 |
| Provider Name | Andrea L Lueck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184145914 PECOS PAC ID: 6709135098 Enrollment ID: I20180820002860 |
| Provider Name | Kipp L Chillag |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518931245 PECOS PAC ID: 1052471844 Enrollment ID: I20180820002884 |
| Provider Name | Katherine Shannon Booker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316367238 PECOS PAC ID: 8921221128 Enrollment ID: I20180827001259 |
| Provider Name | Carla M Grosmann |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497826259 PECOS PAC ID: 4284769548 Enrollment ID: I20181023000624 |
| Provider Name | Tara V Brodersen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1336138882 PECOS PAC ID: 3274825542 Enrollment ID: I20190215001839 |
| Provider Name | Katherine M Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770057135 PECOS PAC ID: 0840530143 Enrollment ID: I20190325000715 |
| Provider Name | Daniel J Beisang |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1649690355 PECOS PAC ID: 7113225889 Enrollment ID: I20190409001640 |
| Provider Name | Lisa B Howley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760538359 PECOS PAC ID: 8224226535 Enrollment ID: I20190418002444 |
| Provider Name | Rebecca Meghann Starling |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1134392533 PECOS PAC ID: 5597985572 Enrollment ID: I20190715000474 |
| Provider Name | Pamela Raja Puthoor |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356504120 PECOS PAC ID: 5092932178 Enrollment ID: I20190715001558 |
| Provider Name | Nital Patel |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1184062663 PECOS PAC ID: 7810293115 Enrollment ID: I20190723002673 |
| Provider Name | Jessica Maikou Vang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588158935 PECOS PAC ID: 6002142270 Enrollment ID: I20190725001092 |
| Provider Name | Phillip M Radke |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1407112881 PECOS PAC ID: 7416253679 Enrollment ID: I20190801000511 |
| Provider Name | Giancarlo A Perez Albela Diaz |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1881003242 PECOS PAC ID: 1658608211 Enrollment ID: I20190806001824 |
| Provider Name | Ian D Thomas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1811250772 PECOS PAC ID: 0749584852 Enrollment ID: I20190816000011 |
| Provider Name | Ashley E Wilson |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1144580424 PECOS PAC ID: 8921318718 Enrollment ID: I20190910000085 |
| Provider Name | Mary E Golden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316495575 PECOS PAC ID: 1557640935 Enrollment ID: I20190911000060 |
| Provider Name | Andrea Leah Paulson |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1255621348 PECOS PAC ID: 3779861752 Enrollment ID: I20190930000106 |
| Provider Name | Renee M Kinney |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1063738847 PECOS PAC ID: 4284966631 Enrollment ID: I20191104002952 |
| Provider Name | Sarah Elizabeth Hoyt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114434834 PECOS PAC ID: 2860824554 Enrollment ID: I20191119000496 |
| Provider Name | Analise Marie Smith Ludwig |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1437384104 PECOS PAC ID: 7517390222 Enrollment ID: I20191211001730 |
| Provider Name | Samuel N Swanson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1902459811 PECOS PAC ID: 1153755038 Enrollment ID: I20191231001491 |
| Provider Name | Julia A Lang |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1316583560 PECOS PAC ID: 5597191841 Enrollment ID: I20200204001804 |
| Provider Name | Victor R Schuring |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1710532718 PECOS PAC ID: 0244666428 Enrollment ID: I20200206001731 |
| Provider Name | Dana C Hoehn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942758701 PECOS PAC ID: 8921435207 Enrollment ID: I20200226001266 |
| Provider Name | Ashley Ann Clintsman |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1629614912 PECOS PAC ID: 7618306937 Enrollment ID: I20200407001451 |
| Provider Name | Deepak Krishan Lachhwani |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1073553541 PECOS PAC ID: 3971500802 Enrollment ID: I20200422002832 |
| Provider Name | Khushabu Kasabwala |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1427476662 PECOS PAC ID: 5890032825 Enrollment ID: I20200527000453 |
| Provider Name | Andrew Mills |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1497142194 PECOS PAC ID: 6901155977 Enrollment ID: I20200609001716 |
| Provider Name | Albert V George |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1700270634 PECOS PAC ID: 4183909658 Enrollment ID: I20200627000091 |
| Provider Name | Paul H Park |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1679927206 PECOS PAC ID: 1759668379 Enrollment ID: I20200706002076 |
| Provider Name | Ahsan Moosa Naduvil Valappil |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477728517 PECOS PAC ID: 2961643804 Enrollment ID: I20200707002560 |
| Provider Name | Brian Jeffrey Carroll |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659799351 PECOS PAC ID: 4284913930 Enrollment ID: I20200708003205 |
| Provider Name | Kurt Alan Madzunovic |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629495981 PECOS PAC ID: 6800184730 Enrollment ID: I20200720000353 |
| Provider Name | Carol Lynn Skerbitz |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1750927554 PECOS PAC ID: 8224454541 Enrollment ID: I20200818001310 |
| Provider Name | Anna C Rauch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184236739 PECOS PAC ID: 5294152526 Enrollment ID: I20200901000628 |
| Provider Name | Amy N Lebedoff |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1841686573 PECOS PAC ID: 9638459183 Enrollment ID: I20200909000631 |
| Provider Name | Ajay Gupta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1679542880 PECOS PAC ID: 8022017961 Enrollment ID: I20200915000011 |
| Provider Name | Harvey Bennett |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1285609495 PECOS PAC ID: 4284670613 Enrollment ID: I20201005001618 |
| Provider Name | Jill Foster |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578511994 PECOS PAC ID: 3274715065 Enrollment ID: I20201016000302 |
| Provider Name | Namita Garg |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1013306885 PECOS PAC ID: 2769894922 Enrollment ID: I20201211000036 |
| Provider Name | Robert Turner |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1982642237 PECOS PAC ID: 5294833018 Enrollment ID: I20210109000139 |
| Provider Name | Liza N Beilke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487162798 PECOS PAC ID: 7416360102 Enrollment ID: I20210120000803 |
| Provider Name | John M Fox |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1447662705 PECOS PAC ID: 1153675046 Enrollment ID: I20210127003451 |
| Provider Name | Carrie J Granbois |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619233632 PECOS PAC ID: 5991119703 Enrollment ID: I20210205000456 |
| Provider Name | Jamie M Eskuri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962829432 PECOS PAC ID: 6608280458 Enrollment ID: I20210206000111 |
| Provider Name | Amanda Joy Dominik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518587120 PECOS PAC ID: 9739597865 Enrollment ID: I20210409000472 |
| Provider Name | Karri Larson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1780220798 PECOS PAC ID: 3971903667 Enrollment ID: I20210617001347 |
| Provider Name | Randi L.s. Lassiter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1619239613 PECOS PAC ID: 7214179308 Enrollment ID: I20210903002425 |
| Provider Name | Alison J Dittmer Flemig |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1932514718 PECOS PAC ID: 7315252368 Enrollment ID: I20211005001028 |
| Provider Name | Lauren Mcclure Yauch |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295120020 PECOS PAC ID: 1557665635 Enrollment ID: I20211007000131 |
| Provider Name | Shannon Andrews |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1548559206 PECOS PAC ID: 4284859695 Enrollment ID: I20211008001201 |
| Provider Name | Emmalynn Sigrist |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346632551 PECOS PAC ID: 7911284641 Enrollment ID: I20211020002293 |
| Provider Name | Eva Christine Igler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497376438 PECOS PAC ID: 4284024811 Enrollment ID: I20211214000546 |
| Provider Name | Margaret Anne Grace |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295499903 PECOS PAC ID: 0941693600 Enrollment ID: I20220202001259 |
| Provider Name | Jason John Mrozek |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1902562234 PECOS PAC ID: 2062805955 Enrollment ID: I20220217001929 |
| Provider Name | Oluwatosin Olajumoke Alabi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720691884 PECOS PAC ID: 7517352255 Enrollment ID: I20220316002697 |
| Provider Name | Natalie Catherine Stork |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174765580 PECOS PAC ID: 2264692557 Enrollment ID: I20220425000664 |
| Provider Name | Charbel El Kosseifi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1376292177 PECOS PAC ID: 6002293305 Enrollment ID: I20220506000046 |
| Provider Name | Venus Vakhshori |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1023490380 PECOS PAC ID: 9133408610 Enrollment ID: I20220526000568 |
| Provider Name | Pang Vang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073265328 PECOS PAC ID: 4880074426 Enrollment ID: I20220629001728 |
| Provider Name | Courtney Anne Carpenter |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1255629911 PECOS PAC ID: 9335364223 Enrollment ID: I20221017000159 |
| Provider Name | Kyle Jacob Miller |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1477917813 PECOS PAC ID: 0749572626 Enrollment ID: I20221017000821 |
| Provider Name | Nickolas Jae Nahm |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1780944330 PECOS PAC ID: 7113159823 Enrollment ID: I20221017001002 |
| Provider Name | April Desiree Benoit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508098856 PECOS PAC ID: 0143454587 Enrollment ID: I20221017003397 |
| Provider Name | Tracy Lee Olmscheid |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1104578152 PECOS PAC ID: 9133596372 Enrollment ID: I20221101002160 |
| Provider Name | Lynn Thomas Randall |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1528710977 PECOS PAC ID: 5991172140 Enrollment ID: I20221101002863 |
| Provider Name | Cathleen Rose Pruitt |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1679952428 PECOS PAC ID: 6002118460 Enrollment ID: I20221115001276 |
| Provider Name | Cindy Kruger Noble |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1538811914 PECOS PAC ID: 6901274992 Enrollment ID: I20221123000219 |
| Provider Name | Tiffany Ann Hale |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1942964564 PECOS PAC ID: 5597133587 Enrollment ID: I20221123000389 |
| Provider Name | April Lee Taylor |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740810332 PECOS PAC ID: 8527436534 Enrollment ID: I20221123001074 |
| Provider Name | Amy Rose Fedie |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1497407837 PECOS PAC ID: 7113395047 Enrollment ID: I20221123002363 |
| Provider Name | Monica Joy Mortenson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1750553699 PECOS PAC ID: 7416325378 Enrollment ID: I20221125000557 |
| Provider Name | Tricia Lee Rude |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1972255339 PECOS PAC ID: 5092183814 Enrollment ID: I20221128002573 |
| Provider Name | Melaina Margery Coppersmith |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326765041 PECOS PAC ID: 1052781747 Enrollment ID: I20221220002690 |
| Provider Name | Sarah Elizabeth Blonsky |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154776664 PECOS PAC ID: 8426312893 Enrollment ID: I20230417001393 |
| Provider Name | Muayad Mamdooh Alali |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1558736405 PECOS PAC ID: 8123321189 Enrollment ID: I20230522000856 |
| Provider Name | Uyen Theresa Truong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457914392 PECOS PAC ID: 9436531258 Enrollment ID: I20230530000415 |
| Provider Name | Kristin Ann Borovsky |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144761578 PECOS PAC ID: 0547628570 Enrollment ID: I20230622002464 |
| Provider Name | Stephanie Cabler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972918175 PECOS PAC ID: 4284903238 Enrollment ID: I20230710001436 |
| Provider Name | Zachary Joseph Johnson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710418371 PECOS PAC ID: 7012287048 Enrollment ID: I20230828000901 |
| Provider Name | Georgi Nicole Brockway |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962629139 PECOS PAC ID: 7810353836 Enrollment ID: I20231001000019 |
| Provider Name | David Chan Yong Van Engen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255035143 PECOS PAC ID: 8123474392 Enrollment ID: I20231024002199 |
| Provider Name | Andrea Lynn Somers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699234310 PECOS PAC ID: 2769830462 Enrollment ID: I20231117002640 |
| Provider Name | Mohamad Sabih Al-rifai |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023016458 PECOS PAC ID: 2163467747 Enrollment ID: I20231220001006 |
| Provider Name | Brian Thomas Campfield |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1265637664 PECOS PAC ID: 8527222876 Enrollment ID: I20240112003657 |
| Provider Name | Leeanna Michelle Moy |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1518615483 PECOS PAC ID: 6901258946 Enrollment ID: I20240116001663 |
| Provider Name | Andrew John Nowalk |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285609651 PECOS PAC ID: 4880747906 Enrollment ID: I20240129000841 |
| Provider Name | Philana Ling Lin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881668028 PECOS PAC ID: 5395805980 Enrollment ID: I20240129001287 |
| Provider Name | Glenn James Rapsinski |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1649633819 PECOS PAC ID: 4284002585 Enrollment ID: I20240129001748 |
| Provider Name | Megan Culler Freeman |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1215399415 PECOS PAC ID: 1153709233 Enrollment ID: I20240130001689 |
| Provider Name | Peter Henderson Ladner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1770147191 PECOS PAC ID: 3779817366 Enrollment ID: I20240206001250 |
| Provider Name | Melanie Marie Reese Maldonado |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1366203788 PECOS PAC ID: 7214370089 Enrollment ID: I20240208002070 |
| Provider Name | Stephanie Kay Campbell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1033755285 PECOS PAC ID: 3577904440 Enrollment ID: I20240509000370 |
Hamline University-counseling And Health Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1513 Englewood Ave, St. Paul, MN 55104 Phone: 651-523-2204 Fax: 651-523-2820 | |
Open Cities Health Center, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 409 N Dunlap Street, St. Paul, MN 55104 Phone: 651-290-9200 Fax: 651-290-9210 | |
Open Cities Health Center, Inc. - Northend Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 916 Rice Street, St. Paul, MN 55117 Phone: 651-290-9200 Fax: 651-290-9210 | |
Open Cities Health Center, Inc. - Rice Street Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 916 Rice Street, St. Paul, MN 55117 Phone: 651-290-9200 Fax: 651-290-9210 |