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General NPI Number Information
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NPI Number | 1154411825
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Entity Type | Individual
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Provider Name | STEVEN DANIEL STASIEWICZ NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4801 VETERANS DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2015
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Country | US
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Telephone | 320-252-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 2219 10TH ST NE
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City | SAUK RAPIDS
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State | MN
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Zip | 56379-9692
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Country | US
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Telephone | 320-259-1648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R106832-6
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License Number State | MN
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