MIA M KOZOJED (NPI# 1124281043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124281043 |
| Entity Type | Individual |
| Full Name | MIA M KOZOJED |
| Other Name | MIA M FYRE |
| Credential | NP |
| Practice Address |
737 Broadway N Fargo ND 58102-4421 |
| Mailing Address |
737 Broadway Fargo ND 58122-0001 |
| Practice Telephone | 7012345121 |
| Practice Fax Number | 7012345124 |
| Mailing Telephone | 7012345121 |
| Mailing Fax Number | 7012345124 |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2008-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | R30620 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
737 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023040219 | Jerome I Thompson | Surgery | 737 Broadway N, Fargo, ND 58122-0001 | 2006-07-07 |
| 1376160184 | Michael Andrew Kerr | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2020-06-26 |
| 1124645064 | Shelby Rae Bucholz | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2020-06-26 |
| 1700431756 | Joshua Jacob Fisher | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-08-06 |
| 1689229122 | Michael Seaman | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-08-01 |
| 1467004838 | Fiona Lillian Axelsson | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-07-15 |
| 1477115145 | Anuj Mogla | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-07-02 |
| 1376105304 | Erika Singh | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2019-06-29 |
| 1467947564 | Katrina Lee Foster | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2018-06-30 |
| 1629590104 | Evelyn Fuentes-dondoneau | Family Medicine | 737 Broadway N, Fargo, ND 58102-4421 | 2017-07-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
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| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1437565330 | Christina Dahl | Nurse Practitioner | 1665 43rd St S Ste 102, Fargo, ND 58103-3316 | 2014-07-11 |
| 1003242256 | Wendy M Moore | Nurse Practitioner | 901 28th St S, Fargo, ND 58103 | 2013-09-19 |
| 1043599277 | Rebecca Ann Kiecker | Nurse Practitioner | 1720 South University Drive, Sanford South University, Fargo, ND 58103 | 2011-08-05 |
| 1780832634 | Sarah M Baker | Nurse Practitioner | 3274 51st St S, Fargo, ND 58104 | 2008-09-04 |
| 1932207149 | Carlee N Leininger | Nurse Practitioner | 2301 25th St S Ste A, Fargo, ND 58103-6104 | 2006-09-20 |
| 1780607788 | Casey M Hoover | Nurse Practitioner | Rejuv Medical Aesthetic Clinic, 3301 45th St S, Fargo, ND 58103 | 2006-07-25 |
| 1023030517 | Tina M Lundeen | Nurse Practitioner | 600 4th St S, Fargo, ND 58103-2804 | 2006-07-24 |
| 1992727481 | Melissa R Erdmann | Nurse Practitioner | 827 28th St S, Unit B, Fargo, ND 58103-8727 | 2006-07-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.