Stephanie Marie Nwala
Individual provider Active NPI Physician Assistant · Windom, MN
NPI 1508129255 · NPPES record last updated Nov 14, 2016
Key facts
- NPI
- 1508129255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2573 (MN)
- Practice address
- 820 2ND Ave N
Windom, MN 56101-1761 - Phone
- (507) 831-1703
- Fax
- (507) 831-5668
- NPI assigned
- Jun 18, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 24
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rural Health Care Inc
Avera McKennan
Practice addresses (Care Compare)
1216 Ryans Rd
Worthington, MN 56187-1781
Phone (507) 372-6522
2020 Hospital Drive
Suite 2
Windom, MN 56101-1761
Phone (507) 831-1703
Hospital & facility affiliations
- Windom Area Health
- Avera McKennan Hospital & University Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161107001254 | MN | Practitioner - Physician Assistant | 3072749423 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2573 | MN | MD | Registered Dietitian |
| 12243 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rural Health Care, Inc | Current |
Accepting new patients | |
| Avera McKennan | Current |
Accepting new patients | |
| Rural Health Care, Inc | Current |
Accepting new patients | |
| Avera McKennan | Current |
Accepting new patients | |
| Rural Health Care, Inc. | Past | Accepting new patients | |
| Avera McKennan | Physician Assistant | Past | Accepting new patients |
Locations
300 S Bruce St
Ste 100
Marshall, MN 56258
2020 Hospital Dr
Ste 1
Windom, MN 56101
Phone (507) 831-1703
2020 Hospital Dr
Ste 2
Windom, MN 56101
Phone (507) 831-1703
820 2nd Ave N
Windom, MN 56101
Phone (507) 831-1370
1216 Ryans Rd
Ste 3
Worthington, MN 56187
Phone (507) 372-6522
305 S State St
Aberdeen, SD 57401
Phone (605) 229-3000
Interoperability endpoints
- stephanie.nwala@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2573 | MN | Yes |
Addresses
Primary practice location
820 2ND Ave N
Windom, MN 56101-1761
Mailing address
820 2ND Ave N
Windom, MN 56101-1761
Phone (507) 831-1703
Other providers in Windom, MN
- James Day Miller
- Karrie Riley Myers
- G P Nelson
- New Song Music Therapy LLC
- Kylie Jo Norell
- Mary L Olson
- PBR Optometrists LTD of Windom
- Kayla Pineda
- Ike Pohlman
- Danelle Porter
All providers in Windom, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.