Individual provider Active NPI

Elizabeth Mary Stecker, RN, CNP

  • Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1871805374
Registry record updated Apr 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R-179585-1 Issued in MN
Practice address
400 E 3Rd St
SMDC Medcial Center Duluth Clinic
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Jul 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R-179585-1 MN Primary

Addresses

Primary practice location

400 E 3Rd St
SMDC Medcial Center Duluth Clinic
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
SMDC Medcial Center Duluth Clinic
Duluth, MN 55805-1951
Phone (218) 786-8364

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110117000244 MN Practitioner - Nurse Practitioner 2668661042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

1542 Golf Course Rd
Suite 204
Grand Rapids, MN 55744-3537
Phone (218) 999-7000

1600 Miller Trunk Hwy
Duluth, MN 55811-5640
Phone (218) 786-5360

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R-179585-1MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD. CurrentSince Oct 11, 2010 Accepting new patients
The Duluth Clinic LTD CurrentSince Oct 11, 2010 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1542 Golf Course Rd
Ste 204
Grand Rapids, MN 55744
Phone (218) 322-4900

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1278979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304035200000",
    "number": "1871805374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "SMDC MEDCIAL CENTER DULUTH CLINIC",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "SMDC MEDCIAL CENTER DULUTH CLINIC",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STECKER",
        "first_name": "ELIZABETH",
        "middle_name": "MARY",
        "credential": "RN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-13",
        "last_updated": "2011-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R-179585-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.