Provider Demographics
NPI:1790779197
Name:BUCKMIER, STEPHANIE F (NP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:F
Last Name:BUCKMIER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:F
Other - Last Name:TWETEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:301 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:MADDOCK
Mailing Address - State:ND
Mailing Address - Zip Code:58348-7138
Mailing Address - Country:US
Mailing Address - Phone:701-438-2555
Mailing Address - Fax:701-438-2551
Practice Address - Street 1:800 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2118
Practice Address - Country:US
Practice Address - Phone:701-776-5455
Practice Address - Fax:701-776-7023
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28617363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459062Medicaid