STACY ANNE PETERLIN (NPI# 1508020769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508020769 |
| Entity Type | Individual |
| Full Name | STACY ANNE PETERLIN |
| Credential | CANP/CFNP |
| Practice Address |
1200 Sixth Ave N Centracare Clinic St Cloud MN 56303-2735 |
| Practice Telephone | 3202525131 |
| Mailing Telephone | 3202525131 |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2011-03-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
R164842-9 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
2008004429 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
R164842-9 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1200 SIXTH AVE N CENTRACARE CLINIC |
| City | ST CLOUD |
| State | MN |
| Zip Code | 56303-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306848122 | Bernard Rudolph Erickson | Internal Medicine | 1200 Sixth Ave N, Centracare Clinic, St Cloud, MN 56303-2735 | 2005-08-11 |
| 1255796918 | Tiffany Nicole Sande | Nurse Practitioner | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2015-12-23 |
| 1417327651 | Larae A. Lymer | Nurse Practitioner | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2015-09-30 |
| 1154799781 | Sarah Catherine Babst | Nurse Practitioner | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2015-09-14 |
| 1376933366 | Milissa Sue Mcduffee | Nurse Practitioner | 1200 Sixth Ave N, Centracare Clinic River Campus/heart & Vascular Center, St Cloud, MN 56303-2735 | 2015-01-28 |
| 1174911127 | Kristin Ann Gjerset | Nurse Practitioner | 1200 Sixth Ave N, Centracare Clinic, St Cloud, MN 56303-2735 | 2014-12-29 |
| 1306253323 | Karen Rae Gozel | Clinical Nurse Specialist | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2014-07-22 |
| 1093120131 | Courtney Lynn Brever | Physician Assistant | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2014-06-27 |
| 1104230879 | Alyssa Marie Monson | Dietitian, Registered | 1200 Sixth Ave N, Centracare Clinic, St Cloud, MN 56303-2735 | 2014-06-20 |
| 1780023846 | Patrick Wayne Odens | Internal Medicine | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2013-06-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255796918 | Tiffany Nicole Sande | Nurse Practitioner | 1200 Sixth Ave N, St Cloud, MN 56303-2735 | 2015-12-23 |
| 1144533290 | Kaylle Rose Schmit Foley | Nurse Practitioner | 1200 Sixth Ave N, Centracare Clinic, St Cloud, MN 56303-2735 | 2010-07-19 |
| 1992796841 | Jill T Stang | Nurse Practitioner | 1520 Northway Court, Centracare Clinic Heartland, St Cloud, MN 56303 | 2005-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639731821 | Thomas Bieniek | Nurse Practitioner | 1900 Centracare Cir Ste 1600, Saint Cloud, MN 56303-5000 | 2019-07-08 |
| 1649830225 | Kimberly Dawn Hanson | Nurse Practitioner | 1884 Randolph Ave, Saint Paul, MN 55105-1747 | 2019-06-17 |
| 1942762828 | Jodi Lynn Martin | Nurse Practitioner | 720 Washington Ave Se Ste 300, Minneapolis, MN 55414-2904 | 2019-04-01 |
| 1831661123 | Sheryl Jo Rudolf | Nurse Practitioner | 705 Pleasant Avenue, Park Rapids, MN 56470-1440 | 2018-12-26 |
| 1043730310 | Alexis Oluwasheun Bakare | Nurse Practitioner | 1101 Paul Pkwy Ne Apt 215, Blaine, MN 55434-3977 | 2017-06-27 |
| 1528500360 | Judy Pauletich | Nurse Practitioner | 1255 Mayhill Rd N, Maplewood, MN 55119-7158 | 2016-11-10 |
| 1437506417 | Zahra Roble | Nurse Practitioner | 1801 Nicolllet Ave S, Minneapolis, MN 55403 | 2016-05-19 |
| 1932569035 | David Makonde Ogato | Nurse Practitioner | 5325 W 74th St, Edina, MN 55439-2231 | 2016-03-02 |
| 1164896379 | Brooke Johnson | Nurse Practitioner | 12700 Whitewater Dr, Minnetonka, MN 55343-9438 | 2015-11-25 |
| 1962879916 | Carrie Rose Lucio | Nurse Practitioner | 807 Albert St N, Saint Paul, MN 55104-1302 | 2015-08-25 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on STACY ANNE PETERLIN.
| 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.