Individual
STACEY MARIA WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10 9TH AVE E, LISBON, ND 58054-4738
(701) 683-4711
(701) 683-3205
Mailing address
10 9TH AVE E, LISBON, ND 58054-4738
(701) 683-4711
(701) 683-3205
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0336
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26331
BCBS ND
ND
Enumeration date
02/02/2006
Last updated
04/29/2014
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