Healthcare Provider Details

I. General information

NPI: 1578458840
Provider Name (Legal Business Name): STACEY LYNN MCCALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 132ND DR NW
WILLISTON ND
58801-8836
US

IV. Provider business mailing address

5824 132ND DR NW
WILLISTON ND
58801-8836
US

V. Phone/Fax

Practice location:
  • Phone: 970-759-0786
  • Fax:
Mailing address:
  • Phone: 970-759-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberR53282
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: