Active NPI
Mark Roy Harstad, RN
- Critical Care Medicine Registered Nurse
- Buffalo, MN
National Provider Identifier
1023542255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Registered Nurse
- License
- R201897-7
- Practice address
- 206 Spruce Ave NE
Buffalo, MN 55313-2517 - Phone
- (763) 333-6075
- NPI assigned
- Apr 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | R201897-7 | MN | Primary |
Addresses
Primary practice location
206 Spruce Ave NE
Buffalo, MN 55313-2517
Mailing address
206 Spruce Ave NE
Buffalo, MN 55313-2517
Phone (763) 333-6075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R201897-7 | MN | MD | Critical Care Medicine Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492041600000",
"number": "1023542255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 SPRUCE AVE NE",
"city": "BUFFALO",
"state": "MN",
"postal_code": "553132517",
"telephone_number": "763-333-6075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 SPRUCE AVE NE",
"city": "BUFFALO",
"state": "MN",
"postal_code": "553132517",
"telephone_number": "763-333-6075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARSTAD",
"first_name": "MARK",
"middle_name": "ROY",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-13",
"last_updated": "2017-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "MN",
"license": "R201897-7",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.