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General NPI Number Information
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NPI Number | 1679133052
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE GAGELIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 1301 33RD ST S
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City | SAINT CLOUD
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State | MN
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Zip | 56301-9668
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Country | US
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Telephone | 320-251-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 4135 LARK CIR
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City | GRAND FORKS
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State | ND
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Zip | 58201-5966
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Country | US
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Telephone | 218-779-8567
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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