Slettum, Stacy Wahl

Slettum, Stacy Wahl is an individual health care provider with primary practice located at 1216 Ryans Rd Ste 3 , Worthington MN 56187-1781. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Slettum, Stacy Wahl can be contacted via phone (507) 375-6522.

Contact Information

Primary practice address
1216 Ryans Rd Ste 3 Worthington MN 56187-1781
Phone: (507) 375-6522
Fax: (507) 372-6573
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2193 Minnesota

Profile Details

NPI number 1942202403
LBN Legal business name Slettum, Stacy Wahl
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2005
Last updated Jul 15th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942202403 NPPES
Massachusetts MEDICAID 118293500

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