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:
Health care specialties
| Specialty | Code | License # | 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 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821059692 | NPPES |
| Minnesota | MEDICAID | 150112700 |
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