NPIMap

Individual provider Active NPI

Penni Marie Weston

  • Family Nurse Practitioner
  • Fargo, ND
National Provider Identifier
1134417140
Registry record updated Dec 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R20495 Issued in ND
Practice address
3902 13TH Ave S
Fargo, ND 58103-3357
Phone
(701) 364-6600
Fax
(701) 364-6628
NPI assigned
Jul 12, 2011
Last updated
Dec 20, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R20495 ND Primary

Addresses

Primary practice location

3902 13TH Ave S
Fargo, ND 58103-3357

Mailing address

1702 University Drive South
Attn: SSC
Fargo, ND 58103-4940
Phone (701) 364-3300

Other identifiers 1

IdentifierTypeStateIssuer
84087MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111004000210 MN Practitioner - Nurse Practitioner 3678650405 Reassigns benefits to 4 organizations
I20111010000490 ND Practitioner - Nurse Practitioner 3678650405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 847-5611

1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-8900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R20495NDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
First Care Medical Services CurrentSince Sep 2, 2025 Accepting new patients
Innovis Health LLC CurrentSince Jan 16, 2012 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health LLC CurrentSince Jan 16, 2012 Accepting new patients
First Care Medical Services CurrentSince Sep 2, 2025 Accepting new patients
Innovis Health LLC Current Accepting new patients
St. Marys Regional Health Center Current Accepting new patients
Innovis Health, LLC. CurrentSince Mar 1, 2012 Accepting new patients
St Mary's Regional Health Center CurrentSince Oct 1, 2025 Accepting new patients
St Marys Regional Health Center Past Accepting new patients

Locations

201 9th St W
Ada, MN 56510
Phone (218) 784-2727

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

900 Hilligoss Blvd SE
Fosston, MN 56542
Phone (218) 435-1133

720 Main Ave
Moorhead, MN 56560
Phone (218) 359-0399

208 Oppegard Ave NW
Twin Valley, MN 56584
Phone (218) 584-5181

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

3902 13th Ave S
Fargo, ND 58103
Phone (701) 282-5880

4622 40th Ave S
Fargo, ND 58104
Phone (701) 232-6211

4622 40th Ave S
#7
Fargo, ND 58104
Phone (701) 364-2909

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513728000000",
    "number": "1134417140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DRIVE SOUTH",
            "address_2": "ATTN: SSC",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033357",
            "telephone_number": "701-364-6600",
            "fax_number": "701-364-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESTON",
        "first_name": "PENNI",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-12",
        "last_updated": "2017-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R20495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84087",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.