Stillwater Medical Group

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

238 Issued in MN

Legal business name

STILLWATER MEDICAL GROUP

Doing business as

The Clinic at Walmart

Practice address

5815 Norell Ave N
Oak Park Heights, MN 55082-1766

Phone

(651) 439-1234

Fax

(651) 275-3325

NPI assigned

Sep 22, 2009

Organization subpart

No

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

Authorized official

Name

Kirk Nybakken

Title

Director of Finance

Phone

(651) 275-3302

Specialties & licenses 2

Addresses

Other names 1

• The Clinic at Walmart Doing business as

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294099200000",
    "number": "1598099772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 CURVE CREST BLVD W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826040",
            "telephone_number": "651-439-1234",
            "fax_number": "651-275-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5815 NORELL AVE N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550821766",
            "telephone_number": "651-439-1234",
            "fax_number": "651-275-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-22",
        "last_updated": "2011-01-04",
        "status": "A",
        "authorized_official_last_name": "NYBAKKEN",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "651-275-3302"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "238",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MN",
            "license": "238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Clinic at Walmart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St. Paul Opticians, Inc.
• Jennifer Ann Stanek, MS, PAC
• Daniel B Stark, DPT
• Danielle M Stark, OTR/L
• Stillwater Family Dental
• Stillwater Modern Dentistry. PC
• Wilfred Oakley Stout, PAC
• Taylors Falls Chiropractic Office LTD
• McKenzie Nicole Tirrel Ostendorf, PT
• Kevin Tran, DDS

• Acute Care Nurse Practitioner in Oak Park Heights, MN
• Providers in Oak Park Heights, MN by specialty
• Acute Care Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.