| Altru Clinic Crookston | |
|
400 S Minnesota St Crookston MN 56716-1808 | |
| (218) 281-9100 | |
| (218) 281-9189 |
| Full Name | Altru Clinic Crookston |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 S Minnesota St, Crookston, Minnesota |
| Authorized Official Name and Position | Derek Goebel (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7017801470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altru Clinic Crookston 400 S Minnesota St Crookston MN 56716-1808 Ph: (218) 281-9100 | Altru Clinic Crookston 400 S Minnesota St Crookston MN 56716-1808 Ph: (218) 281-9100 |
| NPI Number | 1760494330 |
|---|---|
| Provider Enumeration Date | 08/12/2006 |
| Last Update Date | 04/05/2024 |
| Medicare PECOS PAC ID | 1355251604 |
|---|---|
| Medicare Enrollment ID | O20031110000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760494330 | NPI | - | NPPES |
| CD9363 | Other | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | David R Moyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912958448 PECOS PAC ID: 6305740465 Enrollment ID: I20031121000093 |
| Provider Name | Timothy S Yeh |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1912981887 PECOS PAC ID: 9335049279 Enrollment ID: I20040513000163 |
| Provider Name | Ronald C Dorman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750472767 PECOS PAC ID: 6507842473 Enrollment ID: I20040629001592 |
| Provider Name | Valorie N Tuseth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770679037 PECOS PAC ID: 2567449044 Enrollment ID: I20040701001524 |
| Provider Name | Daniel J Walsh |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1093801359 PECOS PAC ID: 2860479342 Enrollment ID: I20040701001578 |
| Provider Name | Mackensie M Brandt |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1871712166 PECOS PAC ID: 3375519820 Enrollment ID: I20040907000302 |
| Provider Name | Peter A Bretzman |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1902884117 PECOS PAC ID: 4082528013 Enrollment ID: I20050222000031 |
| Provider Name | Curtis C Krueger |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952341026 PECOS PAC ID: 3274501192 Enrollment ID: I20050321000137 |
| Provider Name | Christopher A Jackson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073591012 PECOS PAC ID: 7315851094 Enrollment ID: I20050519000455 |
| Provider Name | Mark Veldman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1538188511 PECOS PAC ID: 6305889478 Enrollment ID: I20050609000274 |
| Provider Name | Marcia E Kempton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548293350 PECOS PAC ID: 1658316054 Enrollment ID: I20050627000460 |
| Provider Name | Jeffrey S Phelan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497734123 PECOS PAC ID: 1254245954 Enrollment ID: I20051007000143 |
| Provider Name | Rose B N Brandt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033216817 PECOS PAC ID: 3274570528 Enrollment ID: I20051007000583 |
| Provider Name | Ronald W Brummer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396842175 PECOS PAC ID: 6800806324 Enrollment ID: I20060428000121 |
| Provider Name | Bernie J Dallum |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023109139 PECOS PAC ID: 1254323272 Enrollment ID: I20060428000188 |
| Provider Name | Deborah J Erickson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104917111 PECOS PAC ID: 5597775031 Enrollment ID: I20060428000219 |
| Provider Name | William N Hagen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639260649 PECOS PAC ID: 1355351891 Enrollment ID: I20060428000273 |
| Provider Name | Ralph H Herseth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679664478 PECOS PAC ID: 0244132355 Enrollment ID: I20060428000277 |
| Provider Name | Luis G Jain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073603940 PECOS PAC ID: 4981614328 Enrollment ID: I20060428000282 |
| Provider Name | Martha J Lystad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811088610 PECOS PAC ID: 2860402211 Enrollment ID: I20060428000377 |
| Provider Name | Bryon D Vande Wege |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720174089 PECOS PAC ID: 9133139595 Enrollment ID: I20060428000466 |
| Provider Name | Glen Y Yoshida |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1710073077 PECOS PAC ID: 1850301219 Enrollment ID: I20060428000479 |
| Provider Name | David P Lambert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154384527 PECOS PAC ID: 9436162120 Enrollment ID: I20060725000249 |
| Provider Name | Anne M Nygaard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386653293 PECOS PAC ID: 4688677339 Enrollment ID: I20060817000612 |
| Provider Name | Mevan N Wijetunga |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1457308645 PECOS PAC ID: 3072521640 Enrollment ID: I20060818000028 |
| Provider Name | Matthew J Loe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861419293 PECOS PAC ID: 2769486117 Enrollment ID: I20060828000166 |
| Provider Name | Chad Eugene Boen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1215034095 PECOS PAC ID: 9133117443 Enrollment ID: I20070205000622 |
| Provider Name | Shoua Lo |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1689761785 PECOS PAC ID: 4981606563 Enrollment ID: I20070228000315 |
| Provider Name | Patrick W O'leary |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881672632 PECOS PAC ID: 1254425010 Enrollment ID: I20070924000690 |
| Provider Name | Andrew Hartigan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093793234 PECOS PAC ID: 5294649976 Enrollment ID: I20070928000639 |
| Provider Name | Karleen M Thompson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1013136316 PECOS PAC ID: 3476649567 Enrollment ID: I20071022000037 |
| Provider Name | Roni L Sperle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730379348 PECOS PAC ID: 6709977218 Enrollment ID: I20080408000428 |
| Provider Name | Trent E Siemers |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326154956 PECOS PAC ID: 6709822034 Enrollment ID: I20080523000193 |
| Provider Name | Michael S Rosenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023097755 PECOS PAC ID: 2062326762 Enrollment ID: I20080530000731 |
| Provider Name | Paul F Mulcahy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467431262 PECOS PAC ID: 9234043928 Enrollment ID: I20080531000071 |
| Provider Name | Steven C Hommeyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356329593 PECOS PAC ID: 8325952005 Enrollment ID: I20080602000034 |
| Provider Name | Richard N Aizpuru |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558367789 PECOS PAC ID: 1951215979 Enrollment ID: I20080602000074 |
| Provider Name | Todd M Arsenault |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902890726 PECOS PAC ID: 4688588619 Enrollment ID: I20080602000082 |
| Provider Name | Jeffrey M Barkmeier |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871571083 PECOS PAC ID: 4385558311 Enrollment ID: I20080602000101 |
| Provider Name | Blake A Carlson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548249956 PECOS PAC ID: 8022922780 Enrollment ID: I20080602000174 |
| Provider Name | John M Caspers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750369989 PECOS PAC ID: 2567376221 Enrollment ID: I20080602000293 |
| Provider Name | Matthew T Baldwin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487632725 PECOS PAC ID: 5496669426 Enrollment ID: I20080602000307 |
| Provider Name | Timothy Goertzen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821076068 PECOS PAC ID: 3577477256 Enrollment ID: I20080602000518 |
| Provider Name | John P Knoedler |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023097078 PECOS PAC ID: 7911811609 Enrollment ID: I20080603000224 |
| Provider Name | Matthew J Roller |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1033283379 PECOS PAC ID: 6507866977 Enrollment ID: I20080611000685 |
| Provider Name | Anne Weisensee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992784755 PECOS PAC ID: 8729992433 Enrollment ID: I20080620000583 |
| Provider Name | David Drake |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528046612 PECOS PAC ID: 7517871288 Enrollment ID: I20080620000617 |
| Provider Name | Marla R Love |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1821109422 PECOS PAC ID: 0042119125 Enrollment ID: I20080709000710 |
| Provider Name | Matthew J Spivey |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1790743268 PECOS PAC ID: 5597729616 Enrollment ID: I20080822000685 |
| Provider Name | Joseph V Lazzara |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1609844166 PECOS PAC ID: 9032287149 Enrollment ID: I20081002000345 |
| Provider Name | Anatolie A Usatii |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306890710 PECOS PAC ID: 4587660253 Enrollment ID: I20090106000363 |
| Provider Name | Jacqueline R Devine Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336285931 PECOS PAC ID: 9234293929 Enrollment ID: I20090123000569 |
| Provider Name | James K Sperle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1972699239 PECOS PAC ID: 4688632516 Enrollment ID: I20090421000333 |
| Provider Name | Kevin C Buettner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1942480629 PECOS PAC ID: 2163511254 Enrollment ID: I20090709000771 |
| Provider Name | Scott A Fontaine |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801956792 PECOS PAC ID: 1759370307 Enrollment ID: I20090924000357 |
| Provider Name | Rabeea Aboufakher |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1881896223 PECOS PAC ID: 8325199508 Enrollment ID: I20100415000922 |
| Provider Name | Wade A Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619290590 PECOS PAC ID: 1850429978 Enrollment ID: I20100514000725 |
| Provider Name | Rebecca M Westereng |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1457408239 PECOS PAC ID: 7911006580 Enrollment ID: I20100618000407 |
| Provider Name | David P Sundberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750693784 PECOS PAC ID: 8325162936 Enrollment ID: I20100903000393 |
| Provider Name | Andrew Gasparini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700011459 PECOS PAC ID: 0042407256 Enrollment ID: I20101213001203 |
| Provider Name | James Vodvarka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518955210 PECOS PAC ID: 9335191600 Enrollment ID: I20110124000071 |
| Provider Name | Barbara A Norman |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1043422611 PECOS PAC ID: 6204865157 Enrollment ID: I20110131000883 |
| Provider Name | Jennifer M Peterson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144333022 PECOS PAC ID: 5799966099 Enrollment ID: I20110218000982 |
| Provider Name | Grant R Seeger |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1427252014 PECOS PAC ID: 2365593555 Enrollment ID: I20110527000455 |
| Provider Name | Jeremy Gardner |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1881886497 PECOS PAC ID: 2668664491 Enrollment ID: I20111116000467 |
| Provider Name | Ann L Mason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952696049 PECOS PAC ID: 6406025345 Enrollment ID: I20120530000568 |
| Provider Name | Olumide Ajayi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821228255 PECOS PAC ID: 4183897689 Enrollment ID: I20120710000017 |
| Provider Name | Andres Makarem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831327964 PECOS PAC ID: 5193981611 Enrollment ID: I20120726000662 |
| Provider Name | Mark G Bartlett |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1134162118 PECOS PAC ID: 0244217487 Enrollment ID: I20120821000777 |
| Provider Name | Todor N Dentchev |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1669563771 PECOS PAC ID: 1254468663 Enrollment ID: I20121101000492 |
| Provider Name | Lavanya Bhoopathy |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1891027884 PECOS PAC ID: 4082878012 Enrollment ID: I20121129000449 |
| Provider Name | Adetola Tolulola Haastrup |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1932174588 PECOS PAC ID: 9436176864 Enrollment ID: I20121129000646 |
| Provider Name | Michael C Stephens |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932153830 PECOS PAC ID: 5193782365 Enrollment ID: I20121219000522 |
| Provider Name | Gloria A Ayuck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124391461 PECOS PAC ID: 2769635135 Enrollment ID: I20130115000247 |
| Provider Name | Beth Ann M Nuelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003887076 PECOS PAC ID: 3274572144 Enrollment ID: I20130308000376 |
| Provider Name | Alicia M Wolfgram |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1851664304 PECOS PAC ID: 1254594765 Enrollment ID: I20130516000684 |
| Provider Name | Megan J Thorson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1871862417 PECOS PAC ID: 3072770460 Enrollment ID: I20130627000167 |
| Provider Name | Shivali Devgon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154632503 PECOS PAC ID: 9830339365 Enrollment ID: I20130705000447 |
| Provider Name | Larry Sokolic |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265559785 PECOS PAC ID: 3779723697 Enrollment ID: I20130717000122 |
| Provider Name | Mari Charisse B Trinidad |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336386093 PECOS PAC ID: 3476717729 Enrollment ID: I20130723000205 |
| Provider Name | Jason S Go |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1447475637 PECOS PAC ID: 7719156041 Enrollment ID: I20130729000438 |
| Provider Name | Mikhail Kirnus |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1922272228 PECOS PAC ID: 2860547452 Enrollment ID: I20130924000529 |
| Provider Name | Adam M Mcgauvran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1972858652 PECOS PAC ID: 9234363284 Enrollment ID: I20131008000114 |
| Provider Name | Kelly J Stauss Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306126255 PECOS PAC ID: 0749454114 Enrollment ID: I20131219000257 |
| Provider Name | Stephanie A Kaiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922199728 PECOS PAC ID: 5698798510 Enrollment ID: I20140115000622 |
| Provider Name | Rebecca K Novacek |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861628711 PECOS PAC ID: 1355581315 Enrollment ID: I20140306001407 |
| Provider Name | Danika A Warner Noreen |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1922201029 PECOS PAC ID: 4880861038 Enrollment ID: I20140408000235 |
| Provider Name | Jennifer A Verkuehlen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255773867 PECOS PAC ID: 3678709011 Enrollment ID: I20140425001145 |
| Provider Name | Seth Dorman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841205689 PECOS PAC ID: 2567564420 Enrollment ID: I20140428001244 |
| Provider Name | Daniel R Rustvang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902992266 PECOS PAC ID: 7911044300 Enrollment ID: I20140429000267 |
| Provider Name | Andrew Bunney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114246113 PECOS PAC ID: 5597998096 Enrollment ID: I20140508000511 |
| Provider Name | Jana Zwilling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184873911 PECOS PAC ID: 7214005917 Enrollment ID: I20140529000004 |
| Provider Name | Amanda J Dudgeon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225316433 PECOS PAC ID: 2668643115 Enrollment ID: I20140530000017 |
| Provider Name | Sara Nausheen |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1821261256 PECOS PAC ID: 8527236439 Enrollment ID: I20140611001763 |
| Provider Name | Nkechinyere N Ijioma |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1689872756 PECOS PAC ID: 9638318439 Enrollment ID: I20140617001448 |
| Provider Name | Christian G Khairallah |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1306057450 PECOS PAC ID: 3072638279 Enrollment ID: I20140927000014 |
| Provider Name | Joann J Olson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316039746 PECOS PAC ID: 9638198161 Enrollment ID: I20140927000214 |
| Provider Name | Scott D Charette |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1730274085 PECOS PAC ID: 4385771823 Enrollment ID: I20140930000906 |
| Provider Name | Roshan Ghimire |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184936072 PECOS PAC ID: 9335391135 Enrollment ID: I20141205000648 |
| Provider Name | Ellen K Feldman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831280841 PECOS PAC ID: 9830243906 Enrollment ID: I20141211000803 |
| Provider Name | Leanna M Lauer |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1467877506 PECOS PAC ID: 3375766256 Enrollment ID: I20150114001292 |
| Provider Name | Adam F Nicholson |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1063619237 PECOS PAC ID: 6608055942 Enrollment ID: I20150210000709 |
| Provider Name | Megan H Askelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740692482 PECOS PAC ID: 2264757442 Enrollment ID: I20150210001640 |
| Provider Name | Jody B Treuer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790871051 PECOS PAC ID: 8123210077 Enrollment ID: I20150212001915 |
| Provider Name | Iqbal Masood |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1013176759 PECOS PAC ID: 3375616881 Enrollment ID: I20150217001675 |
| Provider Name | Ashok K Bansal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861599649 PECOS PAC ID: 5991832271 Enrollment ID: I20150218001603 |
| Provider Name | Kevin G Panico |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1225120652 PECOS PAC ID: 0143247205 Enrollment ID: I20150219001577 |
| Provider Name | Kelly M Leach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972836385 PECOS PAC ID: 9931248218 Enrollment ID: I20150303000846 |
| Provider Name | Fatima S Khan |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1235157637 PECOS PAC ID: 1456247196 Enrollment ID: I20150318001249 |
| Provider Name | Jon F Raymond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508958935 PECOS PAC ID: 9133245442 Enrollment ID: I20150324000874 |
| Provider Name | Theresa A Lalonde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912098716 PECOS PAC ID: 2365467339 Enrollment ID: I20150326000093 |
| Provider Name | Samantha M Mcentee |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1558676544 PECOS PAC ID: 8325217060 Enrollment ID: I20150330001130 |
| Provider Name | Lindsey G Miskavige |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1306065602 PECOS PAC ID: 1456581636 Enrollment ID: I20150421001733 |
| Provider Name | Kamrin L Macki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073605408 PECOS PAC ID: 7214053545 Enrollment ID: I20150504000959 |
| Provider Name | Stephanie Suedel |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1053505214 PECOS PAC ID: 4486973815 Enrollment ID: I20150506000327 |
| Provider Name | Pierre A Barbot |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184821985 PECOS PAC ID: 0941470413 Enrollment ID: I20150507002548 |
| Provider Name | Nancy K Lacina |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770702078 PECOS PAC ID: 5395065460 Enrollment ID: I20150514000070 |
| Provider Name | Jody L Paulson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1083760706 PECOS PAC ID: 7012237019 Enrollment ID: I20150514001464 |
| Provider Name | Allan M Nielsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063430122 PECOS PAC ID: 1759414253 Enrollment ID: I20150521002705 |
| Provider Name | Jon R Shereck |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1316931702 PECOS PAC ID: 7719913185 Enrollment ID: I20150629002243 |
| Provider Name | Ashley K Kliner |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285041277 PECOS PAC ID: 5991922106 Enrollment ID: I20150716001710 |
| Provider Name | Bradley C Wehe |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558424150 PECOS PAC ID: 5092911214 Enrollment ID: I20150717001301 |
| Provider Name | Christine M Hanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336527258 PECOS PAC ID: 6204140346 Enrollment ID: I20150803000615 |
| Provider Name | David B Nuelle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376737536 PECOS PAC ID: 9436230364 Enrollment ID: I20150804006054 |
| Provider Name | Trica G De La Hunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104224336 PECOS PAC ID: 3274848635 Enrollment ID: I20150813010615 |
| Provider Name | Jessica L Simmons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679833396 PECOS PAC ID: 0749597193 Enrollment ID: I20150916003261 |
| Provider Name | Sarah L Kuster |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1881094837 PECOS PAC ID: 7315168069 Enrollment ID: I20151104000344 |
| Provider Name | Rebecca A Vigen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922434539 PECOS PAC ID: 6608194063 Enrollment ID: I20151130001105 |
| Provider Name | Paula S Ricke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275916330 PECOS PAC ID: 9335457167 Enrollment ID: I20151210002859 |
| Provider Name | Vanessa M Dufault |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760775548 PECOS PAC ID: 9032434360 Enrollment ID: I20151217001618 |
| Provider Name | Francis Ssali |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1366790990 PECOS PAC ID: 6901117696 Enrollment ID: I20160209001731 |
| Provider Name | Mina Se Hanna |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1205169430 PECOS PAC ID: 0143532457 Enrollment ID: I20160308001957 |
| Provider Name | Tiffany J Eblen |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1174981831 PECOS PAC ID: 5092011601 Enrollment ID: I20160308001970 |
| Provider Name | Cory T Edwards |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770876815 PECOS PAC ID: 3577704857 Enrollment ID: I20160309001174 |
| Provider Name | Laura A Lizakowski |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1730387606 PECOS PAC ID: 5597839464 Enrollment ID: I20160317001694 |
| Provider Name | Lori A Sondrol |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1164518429 PECOS PAC ID: 8820051790 Enrollment ID: I20160331000736 |
| Provider Name | Laura A Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477936029 PECOS PAC ID: 7810200888 Enrollment ID: I20160412001183 |
| Provider Name | Rhea J Ferry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740371756 PECOS PAC ID: 6507909231 Enrollment ID: I20160701000088 |
| Provider Name | Deepak Somashekar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710116918 PECOS PAC ID: 6901118843 Enrollment ID: I20160801001484 |
| Provider Name | Collin Torok |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558523944 PECOS PAC ID: 7911156948 Enrollment ID: I20160801001831 |
| Provider Name | Shanda L Carlson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1134673353 PECOS PAC ID: 3173818960 Enrollment ID: I20160817003009 |
| Provider Name | Rachel M Pearce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629428594 PECOS PAC ID: 3173818887 Enrollment ID: I20160819001056 |
| Provider Name | Erin M Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548613193 PECOS PAC ID: 9830484054 Enrollment ID: I20160825002928 |
| Provider Name | Hayan Al Maluli |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1972814473 PECOS PAC ID: 5698074292 Enrollment ID: I20161004000711 |
| Provider Name | Nicholas Smith |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1629203815 PECOS PAC ID: 8426273277 Enrollment ID: I20161011000264 |
| Provider Name | Sanjay Bindra |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1528080256 PECOS PAC ID: 6709807019 Enrollment ID: I20161117001294 |
| Provider Name | Erin M Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912358771 PECOS PAC ID: 9830482645 Enrollment ID: I20161122001594 |
| Provider Name | Casey J Ryan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497833933 PECOS PAC ID: 3971413220 Enrollment ID: I20161208000186 |
| Provider Name | Amber L Wibbels |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1912312786 PECOS PAC ID: 9739308313 Enrollment ID: I20170831002300 |
| Provider Name | Ekenesenarienrien Cynthia Omokaro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992115737 PECOS PAC ID: 9830465251 Enrollment ID: I20171030001403 |
| Provider Name | Jennifer Lynn Gowan |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1114281540 PECOS PAC ID: 8123273661 Enrollment ID: I20180301000373 |
| Provider Name | Mark W Rodacker |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1437261724 PECOS PAC ID: 6709871239 Enrollment ID: I20180614001377 |
| Provider Name | Beth J Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194210948 PECOS PAC ID: 0547518813 Enrollment ID: I20180802000624 |
| Provider Name | Mohammad Eskandari |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1881959849 PECOS PAC ID: 8921353103 Enrollment ID: I20180910000204 |
| Provider Name | David S Chou |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710926878 PECOS PAC ID: 3072417500 Enrollment ID: I20180917000105 |
| Provider Name | Christopher Lockhart |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1750313045 PECOS PAC ID: 4284675471 Enrollment ID: I20181005000037 |
| Provider Name | Suzanne Grant-gooden |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861611154 PECOS PAC ID: 0042562936 Enrollment ID: I20181116001554 |
| Provider Name | Arshad B Khan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184900466 PECOS PAC ID: 4183978463 Enrollment ID: I20181127000661 |
| Provider Name | Mary B Krogstad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972733186 PECOS PAC ID: 1052464112 Enrollment ID: I20181127002165 |
| Provider Name | Brandon Speidel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699903930 PECOS PAC ID: 5991937104 Enrollment ID: I20181224000022 |
| Provider Name | Mark D Strand |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1720428519 PECOS PAC ID: 4284943200 Enrollment ID: I20181227002439 |
| Provider Name | Kayla Clausen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023504073 PECOS PAC ID: 1153670237 Enrollment ID: I20190103003328 |
| Provider Name | Heather M Shimek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447406129 PECOS PAC ID: 2466509062 Enrollment ID: I20190114000974 |
| Provider Name | Jennifer M Byfuglien |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396185492 PECOS PAC ID: 5890915169 Enrollment ID: I20190306001371 |
| Provider Name | Ashley A Nephew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700371952 PECOS PAC ID: 5092066936 Enrollment ID: I20190411000371 |
| Provider Name | Beth A Anvarinia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093201402 PECOS PAC ID: 5799036497 Enrollment ID: I20190411000672 |
| Provider Name | Candice Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588160063 PECOS PAC ID: 5890035398 Enrollment ID: I20190417001836 |
| Provider Name | Andrea M Eickenbrock |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1093943656 PECOS PAC ID: 4486884988 Enrollment ID: I20190812001902 |
| Provider Name | Michael Dean Branby |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1811237753 PECOS PAC ID: 5698911907 Enrollment ID: I20190815001440 |
| Provider Name | Megan J Christensen |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1902244379 PECOS PAC ID: 3274754668 Enrollment ID: I20190815002500 |
| Provider Name | Jonathan S Haug |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1851482657 PECOS PAC ID: 9739112616 Enrollment ID: I20190815003299 |
| Provider Name | Olivia Carcoana |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1093800344 PECOS PAC ID: 1658559141 Enrollment ID: I20190815003745 |
| Provider Name | Kevin J Mork |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1235248410 PECOS PAC ID: 6305026220 Enrollment ID: I20190817000390 |
| Provider Name | Charlotte J Naveau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508335274 PECOS PAC ID: 6406195189 Enrollment ID: I20190819000009 |
| Provider Name | Stefan Johnson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932338613 PECOS PAC ID: 9931320207 Enrollment ID: I20190819001996 |
| Provider Name | Karen M Staggs |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1629256581 PECOS PAC ID: 8325115298 Enrollment ID: I20190820002293 |
| Provider Name | Michael R Schuster |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1689667909 PECOS PAC ID: 2567498496 Enrollment ID: I20190820003284 |
| Provider Name | Melissa D Secord |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336235696 PECOS PAC ID: 5395702740 Enrollment ID: I20190910002845 |
| Provider Name | Robin K Severud |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1245326503 PECOS PAC ID: 2567487184 Enrollment ID: I20190910003612 |
| Provider Name | Bethany J Gourneau |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1952746851 PECOS PAC ID: 1759687304 Enrollment ID: I20190911002411 |
| Provider Name | Bethany A Harms |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1568553576 PECOS PAC ID: 9234197161 Enrollment ID: I20190911003601 |
| Provider Name | Patrick Walsh |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1467866467 PECOS PAC ID: 9931411550 Enrollment ID: I20190911003838 |
| Provider Name | Benedict Malinao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336698018 PECOS PAC ID: 3375873714 Enrollment ID: I20190926002958 |
| Provider Name | James E Strand |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1699861955 PECOS PAC ID: 9931292448 Enrollment ID: I20190930000424 |
| Provider Name | Jessica A Bratrud |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1073886511 PECOS PAC ID: 0749443604 Enrollment ID: I20190930001329 |
| Provider Name | Vanessa J Sundeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275029225 PECOS PAC ID: 1456600964 Enrollment ID: I20200218002358 |
| Provider Name | Andrea M Riendeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548423932 PECOS PAC ID: 1951460245 Enrollment ID: I20200430001246 |
| Provider Name | Kelsey A Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366965527 PECOS PAC ID: 3678845088 Enrollment ID: I20200804000525 |
| Provider Name | Qin Du |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1942832456 PECOS PAC ID: 6709215023 Enrollment ID: I20200805002782 |
| Provider Name | Arlene G Hampton |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1407075708 PECOS PAC ID: 5294794426 Enrollment ID: I20200810002792 |
| Provider Name | Heidi A Jess |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1144488198 PECOS PAC ID: 7012173917 Enrollment ID: I20200810003524 |
| Provider Name | Coralyn J Jensen Kurtz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871014563 PECOS PAC ID: 1456623842 Enrollment ID: I20200811002795 |
| Provider Name | Laura Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053897074 PECOS PAC ID: 1456609130 Enrollment ID: I20200811003720 |
| Provider Name | Diane M Voeller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225390875 PECOS PAC ID: 2466776778 Enrollment ID: I20200821001890 |
| Provider Name | Shanta Gautham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851562375 PECOS PAC ID: 9133309685 Enrollment ID: I20200826000351 |
| Provider Name | James Erickson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427586312 PECOS PAC ID: 6800229741 Enrollment ID: I20200921001356 |
| Provider Name | Amber Nielsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356871693 PECOS PAC ID: 9537438148 Enrollment ID: I20201005002787 |
| Provider Name | Matthew Thomas Wright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053831990 PECOS PAC ID: 8628342805 Enrollment ID: I20201007002264 |
| Provider Name | Puvanalingam Ayyadurai |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1972919942 PECOS PAC ID: 9830511062 Enrollment ID: I20201008000390 |
| Provider Name | Karine Darbinyan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1134520745 PECOS PAC ID: 5799100434 Enrollment ID: I20201022001173 |
| Provider Name | Cordell R Davis |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1255592903 PECOS PAC ID: 4486809886 Enrollment ID: I20201023001346 |
| Provider Name | Kyle M Rockers |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1225028699 PECOS PAC ID: 0547456105 Enrollment ID: I20201109001522 |
| Provider Name | Brendan M Boe |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1821483728 PECOS PAC ID: 5395058481 Enrollment ID: I20201109002542 |
| Provider Name | Joel D Walz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639265994 PECOS PAC ID: 6709902042 Enrollment ID: I20201123000546 |
| Provider Name | Daniel Kendall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962049445 PECOS PAC ID: 9436584018 Enrollment ID: I20201125001879 |
| Provider Name | Marlie Borowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194386581 PECOS PAC ID: 5698101277 Enrollment ID: I20210105000628 |
| Provider Name | Sarah Traser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952767253 PECOS PAC ID: 9133424625 Enrollment ID: I20210114002820 |
| Provider Name | Andrea S Good |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154899094 PECOS PAC ID: 2860739182 Enrollment ID: I20210419002088 |
| Provider Name | Janessa L Hegstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356945794 PECOS PAC ID: 4880007186 Enrollment ID: I20210512000162 |
| Provider Name | Joshua Deere |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083838411 PECOS PAC ID: 8426124421 Enrollment ID: I20210520002271 |
| Provider Name | Anthony M Duncan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497240709 PECOS PAC ID: 7416206321 Enrollment ID: I20210721000238 |
| Provider Name | Evan Sconce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548835325 PECOS PAC ID: 3476957259 Enrollment ID: I20210916001254 |
| Provider Name | Nicole Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083100036 PECOS PAC ID: 7810246469 Enrollment ID: I20211012000644 |
| Provider Name | Yvonne Gomez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265568851 PECOS PAC ID: 2163559402 Enrollment ID: I20211012002912 |
| Provider Name | Jennifer Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912669029 PECOS PAC ID: 5496144669 Enrollment ID: I20211109001142 |
| Provider Name | Lisa Isler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154096964 PECOS PAC ID: 1557750213 Enrollment ID: I20211223001296 |
| Provider Name | Nicole L Straus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588239263 PECOS PAC ID: 7517368806 Enrollment ID: I20220215002411 |
| Provider Name | Yara L Cameron |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1245518802 PECOS PAC ID: 3072803477 Enrollment ID: I20220411000880 |
| Provider Name | Ethan Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063017432 PECOS PAC ID: 4082011291 Enrollment ID: I20220604000239 |
| Provider Name | Jami L Mathews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912510173 PECOS PAC ID: 1759765092 Enrollment ID: I20220906000364 |
| Provider Name | Beng Loong Isaac Tea |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1013392356 PECOS PAC ID: 9335428812 Enrollment ID: I20230328002492 |
| Provider Name | Aura Patricia Azarcon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902415805 PECOS PAC ID: 4688084700 Enrollment ID: I20231011000149 |
| Provider Name | Gerica Alvarado |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124549464 PECOS PAC ID: 0749602696 Enrollment ID: I20231024001676 |
| Provider Name | Michael Kropp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306092069 PECOS PAC ID: 2668519851 Enrollment ID: I20231205000466 |
| Provider Name | Miranda A Tunheim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245003599 PECOS PAC ID: 0749638518 Enrollment ID: I20231205001045 |
| Provider Name | Nowell Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902678428 PECOS PAC ID: 7618329103 Enrollment ID: I20240119003823 |
Riverview Healthcare Association Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 323 S Minnesota St, Crookston, MN 56716 Phone: 800-743-6551 Fax: 218-281-9509 |