STACEY LEE KONZAK (NPI# 1962486969) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962486969 |
| Entity Type | Individual |
| Full Name | STACEY LEE KONZAK |
| Other Name | STACEY LEE BERG |
| Credential | PA C |
| Practice Address |
2900 E Broadway Ave Bismarck ND 58501-5112 |
| Mailing Address |
5713 80th Ave Ne Devils Lake ND 58301-9657 |
| Practice Telephone | 7012219997 |
| Mailing Telephone | 7013030263 |
| Mailing Fax Number | 7013954456 |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2014-09-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PAC0348 | ND | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 0537 | SD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 71237 | 05 | |
| SD | 6825030 | 05 |
| Street Address |
2900 E BROADWAY AVE |
| City | BISMARCK |
| State | ND |
| Zip Code | 58501-5112 |
| 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 |
| Find all providers in zip 58501 | ||||
| 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 |
|---|---|---|---|---|
| 1831430644 | Danielle Rae Anderson | Physician Assistant | 401 N 9th St # T, Bismarck, ND 58501-4530 | 2013-03-05 |
| 1306123435 | Jamelle Lelito | Physician Assistant | 310 N 9th St Ste 1, Bismarck, ND 58501-4515 | 2011-11-03 |
| 1003038811 | Burton J Mollman | Physician Assistant | 4401 Coleman St Ste 107, Bismarck, ND 58503-1371 | 2007-05-02 |
| 1912925876 | Lori Klabunde | Physician Assistant | 202 E Greenfield Ln Ste 100, Bismarck, ND 58503-6597 | 2006-07-18 |
| 1699704726 | Phyllis Abrahamson | Physician Assistant | 201 N 24th St, Bismarck, ND 58501-4996 | 2006-07-01 |
| 1043255755 | Tracy L Vearrier | Physician Assistant | 2520 N 7th St, Bismarck, ND 58503-1164 | 2006-06-17 |
| 1538769633 | Brenton Michael Green | Physician Assistant | 900 E Broadway Ave, Bismarck, ND 58501-4520 | 2020-10-28 |
| 1346847670 | Hannah Rachel Small | Physician Assistant | 222 N 7th St, Bismarck, ND 58501-4436 | 2020-10-09 |
| 1164030169 | Heather Brooke Flaa | Physician Assistant | 900 E Broadway Ave, Bismarck, ND 58501-4520 | 2020-07-16 |
| 1033769856 | Balance Medical, LLC | Physician Assistant | 1500 Interchange Ave, Bismarck, ND 58501-2084 | 2019-09-13 |
| Find all providers in BISMARCK | ||||
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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.