Unknown Individual – Clinical Nurse Specialist, NPI 1023020484

Unknown Individual is a healthcare provider. based in Marshall, Minnesota. specializing in Clinical Nurse Specialist. They hold a License No. R112994-8 (MN). The NPI Number for Unknown Individual is 1023020484

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1023020484
Phone
Not provided
Address
612 ELAINE AVE
Deactivation Date
13 September 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2187366987
Graduation Year
1988 (38 years ago)
PAC ID
0547303216
Group Practice PAC ID
1759291891
Professional Enrollment ID
I20100203000180
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 612, Elaine Avenue, Marshall, Lyon County, Minnesota, 56258, United States

    MARSHALL, MN 562582240

    Phone:

    Type: Mailing

  • 1212, East College Drive, Marshall, Lyon County, Minnesota, 56258, United States

    MARSHALL, MN 562582010

    Phone: (507) 532-3236

    Fax: (507) 532-0240

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 56258)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1759291891View full group profile
NameSpecialtyState
-MN
Mental Health CounselorMN
Clinical Social WorkerND
Clinical Social WorkerTX
Mental Health CounselorMN
Mental Health CounselorMN
P S Y C H I A T R YMN
Mental Health CounselorMN
Nurse PractitionerMN
Clinical Social WorkerMN

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1023020484?
NPI 1023020484 belongs to Unknown Individual; compare other details if you need extra assurance.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Clinical Nurse Specialist in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Marshall, Minnesota as the reference point for Unknown Individual, then confirm.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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