MALLORI WALTERS (NPI# 1831556125) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1831556125 |
Entity Type | Individual |
Full Name | MALLORI WALTERS |
Credential | PA |
Practice Address |
3850 Park Nicollet Blvd St Louis Park MN 55416-2527 |
Mailing Address |
8170 33rd Ave S Po Box 1309 Mail Stop 21110q Minneapolis MN 55425-4516 |
Practice Telephone | 9528831000 |
Enumeration Date | 2016-01-19 |
Last Update Date | 2020-04-02 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363A00000X | Physician Assistant | 12110 | MN | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
3850 PARK NICOLLET BLVD |
City | ST LOUIS PARK |
State | MN |
Zip Code | 55416-2527 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487659587 | Debra Ann Rustad | Nurse Practitioner | 3850 Park Nicollet Blvd, Park Nicollet Clinic--senior Services-- 3rd Floor, St Louis Park, MN 55416-2527 | 2005-06-15 |
1386280030 | Melissa Jean Neiert | Social Worker | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-11-18 |
1083261101 | Annemarie Rose Kettler | Dietitian, Registered | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-08-22 |
1427601772 | Michaela Rae Schleinz | Occupational Therapist | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-07-16 |
1720545627 | Rose Alicia Crider | Dietitian, Registered | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-02-27 |
1114435773 | Adam James Uithoven | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-01-17 |
1285140442 | Jessica Mae Brabender | Nurse Practitioner | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-12-22 |
1043729064 | Grace Marie Irish | Nurse Practitioner | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-09-21 |
1760908131 | Elin Christine Pool | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-08-17 |
1912422718 | Kathleen Therese Guinee Holman | Nurse Practitioner | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2017-08-14 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
Find all providers in zip 55416 |
Taxonomy Code | 363A00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780284844 | Lily Ganz | Physician Assistant | 2737 Huntington Ave, St Louis Park, MN 55416-3917 | 2020-10-28 |
1710298336 | Scott Marshall Schmaedeke | Physician Assistant | 1155 Ford Rd Ste B, St Louis Park, MN 55426-1115 | 2010-06-29 |
1821075425 | Courtney L Scott | Physician Assistant | 6490 Excelsior Blvd # E500, Park Nicollet Clinic - Meadowbrook, St Louis Park, MN 55426 | 2005-12-27 |
1619504768 | Devanie Tucker | Physician Assistant | 3808 Grand Way, St Louis Park, MN 55416-4788 | 2020-03-26 |
1083257612 | Kaylie Marie Laplante | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-10-27 |
1164994133 | Erik Junso | Physician Assistant | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2019-01-01 |
1144790866 | Ashley Marie Overby | Physician Assistant | 5525 Cedar Lake Rd S, St Louis Park, MN 55416-1420 | 2018-11-26 |
1043790553 | Jack William Bergman | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-08-15 |
1164922910 | Lisa Mary Huset | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-02-19 |
1114435773 | Adam James Uithoven | Physician Assistant | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-01-17 |
Find all providers in ST LOUIS PARK |
City | ST LOUIS PARK |
Zip Code | 55416 |
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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.