Active NPI
Stephanie Rae Walvatne, N.P.
- Nurse Practitioner
- Coon Rapids, MN
National Provider Identifier
1689074155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R135327-7
- Practice address
- 3887 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2518 - Phone
- (763) 427-8547
- Fax
- (763) 576-5394
- NPI assigned
- Sep 2, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R135327-7 | MN | Primary |
Addresses
Primary practice location
3887 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2518
Mailing address
3887 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2518
Phone (763) 427-8547
Other names 1
- Stephanie Rae Erickson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11855 Ulysses St NE
Suite 220
Blaine, MN 55434-4181
Phone (763) 427-8547
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R135327-7 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vascular Surgery Associates PA | Current | Accepting new patients |
Locations
11855 Ulysses St NE
Ste 220
Minneapolis, MN 55434
Phone (763) 427-8547
3887 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (612) 217-3689
Interoperability endpoints
- vascularsurgeryassociates.stephaniewalvatne@117099.advancedmd-direct.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Vascular Surgery Physician
- Blaine, MN
- NPI 1083894836
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409616000000",
"number": "1689074155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3887 COON RAPIDS BLVD NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554332518",
"telephone_number": "763-427-8547",
"fax_number": "763-576-5394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3887 COON RAPIDS BLVD NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554332518",
"telephone_number": "763-427-8547",
"fax_number": "763-576-5394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALVATNE",
"first_name": "STEPHANIE",
"middle_name": "RAE",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-02",
"last_updated": "2014-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R135327-7",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "ERICKSON",
"middle_name": "RAE",
"credential": "R.N.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.