Stanke, Jerry Wayne
Stanke, Jerry Wayne is an individual health care provider with primary practice located at 3555 Willow Lake Blvd Suite 240, Saint Paul MN 55110-5131. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Stanke, Jerry Wayne can be contacted via phone (651) 770-0110.Contact Information
Primary practice address
3555 Willow Lake Blvd Suite 240
Saint Paul MN 55110-5131
Phone: (651) 770-0110
Fax: (651) 770-0134
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 22442 | Minnesota |
Profile Details
| NPI number | 1043329220 |
|---|---|
| LBN Legal business name | Stanke, Jerry Wayne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 30th, 2006 |
| Last updated | Jan 28th, 2013 - about 11 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 | 1043329220 | NPPES |
| Minnesota | MEDICAID | 553002400 |
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