JEFFREY MARK WIISANEN (NPI# 1306282025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306282025 |
| Entity Type | Individual |
| Full Name | JEFFREY MARK WIISANEN |
| Credential | MD |
| Practice Address |
820 4th St N Fargo ND 58102-4539 |
| Practice Telephone | 7012346161 |
| Practice Fax Number | 7012347592 |
| Mailing Telephone | 7012346161 |
| Mailing Fax Number | 7012347592 |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2019-09-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 58264 | MN | Allopathic & Osteopathic Physicians |
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
58264 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
820 4TH ST N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922025907 | Anu G Gaba | Internal Medicine | 820 4th St N, Fargo, ND 58122-0001 | 2006-07-16 |
| 1023629631 | Pauline Aamodt | Genetic Counselor, MS | 820 4th St N, Fargo, ND 58102-4539 | 2020-08-17 |
| 1710507561 | Brittany Nicole Twiss | Dietitian, Registered | 820 4th St N, Fargo, ND 58102-4539 | 2020-04-22 |
| 1366092801 | Sanford Medical Center Fargo | Hospice Care, Community Based | 820 4th St N, Fargo, ND 58102-4539 | 2019-09-17 |
| 1154807741 | Morgan Rinke | Nurse Practitioner | 820 4th St N, Fargo, ND 58102-4539 | 2018-07-17 |
| 1497269583 | Ethan Joseph Brenna | Genetic Counselor, MS | 820 4th St N, Fargo, ND 58102-4539 | 2017-11-28 |
| 1265885867 | Carrie Pfaff | Nurse Practitioner | 820 4th St N, Fargo, ND 58102-4539 | 2016-07-19 |
| 1316315385 | Sharri M Lacher | Clinical Nurse Specialist | 820 4th St N, Fargo, ND 58102-4539 | 2015-09-09 |
| 1487022885 | John Roll | Clinical Nurse Specialist | 820 4th St N, Fargo, ND 58102-4539 | 2015-09-02 |
| 1699181495 | Kirk David Wyatt | Pediatrics | 820 4th St N, Fargo, ND 58102-4539 | 2014-07-01 |
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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 | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013938752 | Howard L Russell | Internal Medicine | 820 N 4th St, Fargo, ND 58122-0001 | 2006-07-21 |
| 1922025907 | Anu G Gaba | Internal Medicine | 820 4th St N, Fargo, ND 58122-0001 | 2006-07-16 |
| 1578536728 | Shelby A Terstriep | Internal Medicine | 820 4 Street North, Fargo, NC 58122 | 2006-02-08 |
| 1982917506 | Abdallah Abou Zahr | Internal Medicine | 820 4th St N, Fargo, ND 58102-4539 | 2010-07-24 |
| 1043426034 | Amit Panwalkar | Internal Medicine | 820 4th St N, Fargo, ND 58102-4539 | 2007-05-15 |
| 1134141708 | John Michael Tate | Internal Medicine | 1702 University Dr S, Fargo, ND 58103-4940 | 2006-07-24 |
| 1013935667 | Gerald G Gross | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
| 1770500639 | Louis H Geeraerts | Internal Medicine | 820 4th St N, Fargo, ND 58122-0001 | 2006-07-16 |
| 1508899139 | Mahendra K Gupta | Internal Medicine | 1702 University Dr S, Fargo, ND 58103-4940 | 2006-07-08 |
| 1376585281 | Janet Elaine Macheledt | Internal Medicine | 1702 University Dr S, Fargo, ND 58103-4940 | 2006-06-12 |
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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.