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General NPI Number Information
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NPI Number | 1558041616
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Entity Type | Individual
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Provider Name | ALIX R STALMAKOV ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3701 12TH ST N STE 201
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2253
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Country | US
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Telephone | 320-229-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 12TH ST N STE 201
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2253
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Country | US
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Telephone | 320-229-3760
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | G175225
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10957
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License Number State | MN
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