Provider Demographics
NPI:1194237479
Name:SHRESTHA, STACY (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:LUKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 NORTHLAND CIRCLE N
Mailing Address - Street 2:STE 119
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428
Mailing Address - Country:US
Mailing Address - Phone:952-456-6160
Mailing Address - Fax:952-835-9830
Practice Address - Street 1:7100 NORTHLAND CIRCLE N
Practice Address - Street 2:STE 119
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428
Practice Address - Country:US
Practice Address - Phone:952-456-6160
Practice Address - Fax:952-835-9830
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2066288363LA2200X
MN5318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health