Organization
STILLWATER MEDICAL GROUP
Active
Other names
The Clinic at Walmart
Organization subpart
No
Provider details
NPI number
Authorized official
KIRK NYBAKKEN (DIRECTOR OF FINANCE)
(651) 275-3302
Entity
Organization
Contact information
Practice address
5815 NORELL AVE N, OAK PARK HEIGHTS, MN 55082-1766
(651) 439-1234
(651) 275-3325
Mailing address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 275-3325
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
238
MN
363LA2100X
Acute Care Nurse Practitioner
Primary
238
MN
Other
Enumeration date
09/22/2009
Last updated
01/04/2011
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