MEDICARE: STACIA CHERNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1003745753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIA CHERNE

Provider Business Mailing Address
First Line	:	4575 32ND AVE S STE 3
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4575 32ND AVE S STE 3
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3305
Country	:	US
Telephone Number	:	701-353-7579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/26/2026

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Directions to “ STACIA CHERNE ” Practice Location

Language	Start Address	Practice Location

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