Healthcare Provider Details

I. General information

NPI: 1568379824
Provider Name (Legal Business Name): STEPHANIE LEIGH PALANUK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 28TH AVE S
MOORHEAD MN
56560-7926
US

IV. Provider business mailing address

4011 9TH ST S
MOORHEAD MN
56560-7471
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-8880
  • Fax:
Mailing address:
  • Phone: 651-890-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number2380595
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: