STACY ANN CEDERSTROM (NPI# 1174079917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174079917 |
| Entity Type | Individual |
| Full Name | STACY ANN CEDERSTROM |
| Other Name | STACY ANN TANDESKI |
| Credential | FNP |
| Practice Address |
425 7th Street North East Cass Lake MN 56633 |
| Practice Telephone | 2183353200 |
| Practice Fax Number | 2183353300 |
| Mailing Telephone | 2183353200 |
| Mailing Fax Number | 2183353300 |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2019-04-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
CNP4566 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | FNP LICENSE | CNP4566 | 01 |
| MN | DNP | MC3911028 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1120 E 34th St, Hibbing, MN 557462909 | 2183627100 | 2183627131 |
| Street Address |
425 7TH STREET NORTH EAST |
| City | CASS LAKE |
| State | MN |
| Zip Code | 56633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205485430 | Jessica Rose Malterud | Registered Nurse | 416-2nd Street Nw, Cass Lake, MN 56633 | 2019-09-10 |
| 1679933568 | Minnesota Chippewa Tribe Adult Day Services | Clinic/Center | 15546 State 371 Nw, Cass Lake, MN 56633 | 2016-03-04 |
| 1073979084 | Constance J Mangiamele | Registered Nurse | 190 Sailstar Dr. Nw, Cass Lake, MN 56633 | 2016-01-06 |
| 1194193086 | Whitney Dickson | Pharmacist | 425 7th Street Northwest, Cass Lake, MN 56633 | 2015-09-09 |
| 1245669332 | Marsha Ellen Kaehne | Nurse Practitioner | 119 Aspen Ave., Cass Lake, MN 56633 | 2013-11-08 |
| 1376985952 | Home Free Care, LLC | Home Health | 310 Norway Ave. Ne, Cass Lake, MN 56633 | 2013-07-23 |
| 1831468479 | Leech Lake Band of Ojibwe | Substance Abuse Rehabilitation Facility | 113 7th Stree Nw, Cass Lake, MN 56633 | 2011-12-28 |
| 1275823742 | Leech Lake Band of Ojibwe | Community/Behavioral Health | 16123 Grant Utley Ave Nw, Cass Lake, MN 56633 | 2011-04-18 |
| 1659679843 | Leech Lake Band of Ojibwe | Community/Behavioral Health | 115 6th Street Nw, Cass Lake, MN 56633 | 2011-03-11 |
| 1831491315 | Rita Marie Schuldt | Dietitian, Registered | 115 6th St. Nw Ste. 6, Cass Lake, MN 56633 | 2010-12-03 |
| Find all providers in zip 56633 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023269552 | Sharon Kay Walker | Nurse Practitioner | 16046 Roosevelt Rd Se, Cass Lake, MN 56633-3202 | 2008-10-02 |
| 1497911440 | Karey Marlene Lyon | Nurse Practitioner | 115 6th St Ne, Suite E, Cass Lake, MN 56633-3428 | 2008-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466368 | Amalia Jo Folland Harvey | Nurse Practitioner | 19883 Evensong Ct, Farmington, MN 55024-8688 | 2020-10-29 |
| 1710586235 | Jackelyn Laura Peterson | Nurse Practitioner | 10101 Bren Rd E Unit 345, Minnetonka, MN 55343-0060 | 2020-10-26 |
| 1578162509 | Mckenzie Mcadaragh | Nurse Practitioner | 10924 Girard Curve, Bloomington, MN 55431 | 2020-10-21 |
| 1861091704 | Morgan Rohl | Nurse Practitioner | 117 12th Ave Nw Apt 2, Rochester, MN 55901-2787 | 2020-10-21 |
| 1063010304 | Kalie R Mccauley | Nurse Practitioner | 11452 Brook Rd Nw, Elk River, MN 55330-8739 | 2020-10-09 |
| 1659978930 | Sarah Jean Mudge | Nurse Practitioner | 350 Harbor Dr, Duluth, MN 55802-2600 | 2020-10-08 |
| 1285231621 | Karlu Dorleh | Nurse Practitioner | 14151 Territorial Rd Unit 212, Maple Grove, MN 55369-5725 | 2020-10-08 |
| 1447857669 | Kimberly Dawn Bursch-tewalt | Nurse Practitioner | 11884 237th Ave Nw, Elk River, MN 55330-8255 | 2020-10-01 |
| 1639786312 | Peter Wahl | Nurse Practitioner | 4652 Lyndale Ave S, Minneapolis, MN 55419-5302 | 2020-09-28 |
| 1568078616 | Joanna Kay Rehm | Nurse Practitioner | 3025 Eagandale Pl Apt 338, Eagan, MN 55121-1236 | 2020-09-23 |
| Find all providers with the same taxonomy | ||||
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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.