Healthcare Provider Details

I. General information

NPI: 1861648636
Provider Name (Legal Business Name): MEGHAN AMANDA STADSKLEV RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 3RD AVE E
OSAKIS MN
56360-4401
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

V. Phone/Fax

Practice location:
  • Phone: 208-593-0383
  • Fax:
Mailing address:
  • Phone: 320-763-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR167372-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number384
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: