EVOLVE DERMATOLOGY (NPI# 1629541172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629541172 |
| Entity Type | Organization |
| Organization Name | EVOLVE DERMATOLOGY |
| Practice Address |
401 N 9th St Bismarck ND 58501-4530 |
| Mailing Address |
1646 28th Ave. S. #10 Grand Forks ND 58201 |
| Practice Telephone | 7017124899 |
| Practice Fax Number | 7017124225 |
| Mailing Telephone | 7017400052 |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2019-11-19 |
| Authorized Official Name | JENNIFER TINKLER (OWNER) |
| Authorized Official Telephone | 7017400052 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EVOLVE DERMATOLOGY LLC | 1646 28th Ave S Apt 10, Grand Forks, ND 58201-6760 |
| Street Address |
401 N 9TH ST |
| City | BISMARCK |
| State | ND |
| Zip Code | 58501-4530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235124934 | Stewart A. Sharp | Specialist | 401 N 9th St, Bismarck, ND 58501-4506 | 2005-09-19 |
| 1346856002 | Stephanie L Jensen | Dietitian, Registered | 401 N 9th St, Bismarck, ND 58501-4506 | 2020-09-18 |
| 1447897897 | 701 Anesthesia Associates, Pllc | Nurse Anesthetist, Certified Registered | 401 N 9th St, Bismarck, ND 58501-4530 | 2019-12-04 |
| 1962059915 | Brightside Surgical, LLC | Surgery | 401 N 9th St, Bismarck, ND 58501-4530 | 2019-08-23 |
| 1770029613 | Heritage Pharmacy East Inc | Pharmacy | 401 N 9th St, Bismarck, ND 58501-4530 | 2017-01-17 |
| 1497205876 | Sommer Fields | Physician Assistant | 401 N 9th St, Bismarck, ND 58501-4530 | 2016-10-10 |
| 1902257454 | Jenny Schmidt | Dietitian, Registered | 401 N 9th St, Bismarck, ND 58501-4530 | 2016-06-27 |
| 1659776805 | Laura Frances Roemmich | Physician Assistant | 401 N 9th St, Bismarck, ND 58501-4530 | 2014-10-30 |
| 1568877827 | Eric J Lutzwick | Nurse Practitioner | 401 N 9th St, Bismarck, ND 58501-4530 | 2014-06-25 |
| 1881014843 | Vanessa Gallegos-kearin | Physical Medicine & Rehabilitation | 401 N 9th St, Bismarck, ND 58501-4506 | 2014-04-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811500911 | Sonja Lee Bosch | Counselor | 101 E. Broadway Ave Heartview Foundation, Bismarck, ND 58501 | 2020-08-28 |
| 1649740630 | Stephanie Marie Simburger | Social Worker | 3111 East Broadway Ave, Bismarck, ND 58501 | 2018-12-03 |
| 1679042519 | Prairie Rose Family Dentists | Dentist | 1110 College Dr., Suite 110, Bismark, ND 58501 | 2018-11-21 |
| 1386111276 | Arielle Joy Flynn | Genetic Counselor, MS | 414 N Seventh Street, Bismarck, ND 58501 | 2018-10-29 |
| 1164901799 | Karalee Joy Harper | Counselor | 101 E. Broadway Ave, Bismarck, ND 58501 | 2018-08-14 |
| 1518457811 | Myckenzie Saari | Behavior Technician | 1929 N Washington St., Bismarck, ND 58501 | 2018-05-14 |
| 1831687532 | Jacquelyn Mahoney | Behavioral Analyst | 604 North Ave, Bismarck, ND 58501 | 2018-04-27 |
| 1710403811 | Kayla Marie Watson | Behavior Technician | 1500 E. Capitol Ave, Suite 200, Bismarck, ND 58501 | 2017-08-21 |
| 1306368220 | Scott Vandyke | Occupational Therapist | 300 N. 7th St, Bismarck, ND 58501 | 2017-07-12 |
| 1144670019 | Bismarck Psychological Associates, Pllc | Psychologist | 107 W. Main Ave., Suite 225, Bismarck, ND 58501 | 2016-06-21 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952360711 | William Eugene Cornatzer Jr. | Dermatology | 225 N 7th St # 2, United Bank Bldg, Bismarck, ND 58501-4417 | 2006-03-21 |
| 1952383226 | Nicole Marie Soto | Dermatology | 2830 N Washington St, Bismarck, ND 58503-1482 | 2005-11-14 |
| 1992199244 | Imran Aslam | Dermatology | 2830 N Washington St, Bismarck, ND 58503-1482 | 2015-03-25 |
| 1386970671 | William E. Cornatzer, Jr., M.d., P.C. | Dermatology | 225 N 7th St # 2, United Bank Bldg, Bismarck, ND 58501-4417 | 2009-10-22 |
| 1043447360 | Asha Patel Shah | Dermatology | 715 E Broadway Ave, Bismarck, ND 58501-4451 | 2009-06-12 |
| 1811149156 | Richelle Melanie Knudson | Dermatology | 2830 N Washington St, Bismarck, ND 58503-1482 | 2008-10-17 |
| 1649224809 | Joseph Mark Ebertz | Dermatology | 2700 State St, Bismarck, ND 58503-0669 | 2006-05-20 |
| 1174577332 | Joseph A Luger | Dermatology | 701 E Rosser Ave, Bismarck, ND 58501 | 2006-05-20 |
| 1144294208 | David L Appert | Dermatology | 2830 N Washington St, Bismarck, ND 58503-1482 | 2006-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750648366 | Saba Zabetian | Dermatology | 3165 Demers Ave, Grand Forks, ND 58201-4049 | 2012-04-19 |
| 1205006897 | Daniel Morse Hoffman | Dermatology | 1213 15th Ave W Ste 102, Williston, ND 58801-3800 | 2008-03-10 |
| 1205031713 | Rachel C Ness | Dermatology | 3173 43rd Street S Ste A, Fargo, ND 58104-4564 | 2007-06-15 |
| 1902978455 | Beth A Honl | Dermatology | 4133 30th Ave S Ste 101, Fargo, ND 58104-8421 | 2006-11-13 |
| 1952408809 | Chetan P Maingi | Dermatology | 4556 40th Avenue South, Suite 130, Fargo, ND 58104 | 2006-09-20 |
| 1639121304 | Thomas J Matzke | Dermatology | 4656 40th Ave S, Fargo, ND 58104-4397 | 2006-05-17 |
| 1245223023 | Kimberly Rae Kelly | Dermatology | 1702 University Dr S, Fargo, ND 58103-4940 | 2005-08-26 |
| 1992343198 | Skin Win Dermatology PC | Dermatology | 1213 15th Ave W Ste 102, Williston, ND 58801-3800 | 2019-12-18 |
| 1912359977 | Natalie Marie Kollman | Dermatology | 1702 University Dr S, Fargo, ND 58103-4940 | 2016-07-01 |
| 1043666274 | Dong Kim | Dermatology | 1702 University Dr S, Fargo, ND 58103-4940 | 2016-05-06 |
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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.