Provider Demographics
NPI:1144248212
Name:STOCK, NANCY J (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:STOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 2ND STREET NW
Mailing Address - Street 2:
Mailing Address - City:TWIN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56584
Mailing Address - Country:US
Mailing Address - Phone:218-584-5142
Mailing Address - Fax:218-584-5399
Practice Address - Street 1:501 2ND STREET NW
Practice Address - Street 2:
Practice Address - City:TWIN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56584
Practice Address - Country:US
Practice Address - Phone:218-584-5142
Practice Address - Fax:218-584-5399
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR104074-2363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
0117666OtherMEDICA
ND19548Medicaid
HP20535OtherHEALTHPARTNERS
1014567OtherPREFERREDONE
87A97STOtherMN BC
17648OtherNDBC
87A97STOtherMN BC