Ko, Stacey L

Ko, Stacey L is an individual health care provider with primary practice located at 7500 80Th St S, Suite 100 - Ms 34624A Healthpartners Cottage Grove Clinic, Cottage Grove MN 55016-3008. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Ko, Stacey L can be contacted via phone (651) 415-4100.

Contact Information

Primary practice address
7500 80Th St S, Suite 100 - Ms 34624A Healthpartners Cottage Grove Clinic Cottage Grove MN 55016-3008
Phone: (651) 415-4100
Fax: (651) 415-4101
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 9655 Minnesota

Profile Details

NPI number 1821059692
LBN Legal business name Ko, Stacey L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Mar 11th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821059692 NPPES
Minnesota MEDICAID 150112700

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