STACEY LEE KONZAK


Address: 2900 E Broadway Ave, Bismarck, ND 58501-5112
Phone: 7012219997

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
ND 71237 05
SD 6825030 05

Office Location

Street Address 2900 E BROADWAY AVE
City BISMARCK
State ND
Zip Code 58501-5112

Providers in the same zip code

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 Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

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
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Competitor

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City BISMARCK
Zip Code 58501

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Dataset Information

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.

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