Healthcare Provider Details

I. General information

NPI: 1255189460
Provider Name (Legal Business Name): JUSTIN JAMES STUART PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 S WASHINGTON ST
GRAND FORKS ND
58201-5766
US

IV. Provider business mailing address

PO BOX 5210
GRAND FORKS ND
58206-5210
US

V. Phone/Fax

Practice location:
  • Phone: 701-205-3000
  • Fax: 701-732-2501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: