Individual
STACEY PFENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
200 S 5TH ST, BISMARCK, ND 58504-5675
(701) 222-3937
(701) 222-8805
Mailing address
200 S 5TH ST, BISMARCK, ND 58504-5675
(701) 222-3937
(701) 222-8805
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R27350
ND
363LF0000X
Family Nurse Practitioner
Primary
R27350
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1451286
—
ND
05
—
19750
—
ND
01
—
500028258
RR MEDICARE
ND
01
—
R27350
LICENSE
ND
Enumeration date
02/16/2007
Last updated
12/23/2019
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