Individual
SHALISHAH STAUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
803 6TH ST NW, MINOT, ND 58703-2210
(419) 733-6542
Mailing address
1410 30TH AVE NW APT 8305, MINOT, ND 58703-5096
(419) 733-6542
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R40922
ND
363LF0000X
Family Nurse Practitioner
R40922
ND
Other
Enumeration date
06/14/2023
Last updated
01/05/2024
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