Individual
COLEEN STALOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
310 N 9TH ST, BISMARCK, ND 58501-4508
(701) 530-8800
Mailing address
310 N 9TH ST, BISMARCK, ND 58501-4515
(701) 530-8800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0041
ND
363L00000X
Nurse Practitioner
R19160
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27445
BCBS
ND
Enumeration date
12/14/2006
Last updated
10/25/2019
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