Active NPI
Myrna B Stuefen, PAC
- Physician Assistant
- Mankato, MN
National Provider Identifier
1790738631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0399
- Practice address
- 1400 Madison Ave
Suite 402
Mankato, MN 56001-5473 - Phone
- (507) 625-7246
- Fax
- (507) 386-2599
- NPI assigned
- May 19, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0399 | SD | Primary |
Addresses
Primary practice location
1400 Madison Ave
Suite 402
Mankato, MN 56001-5473
Mailing address
4131 W Loomis Rd
Suite 300
Greenfield, WI 53221-2057
Phone (414) 325-7246
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0399 | SD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398643200000",
"number": "1790738631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4131 W LOOMIS RD",
"address_2": "SUITE 300",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "532212057",
"telephone_number": "414-325-7246",
"fax_number": "414-325-3770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 MADISON AVE",
"address_2": "SUITE 402",
"city": "MANKATO",
"state": "MN",
"postal_code": "560015473",
"telephone_number": "507-625-7246",
"fax_number": "507-386-2599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUEFEN",
"first_name": "MYRNA",
"middle_name": "B",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2014-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.