Healthcare Provider Details

I. General information

NPI: 1518940139
Provider Name (Legal Business Name): CAROLYN D STELTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S 4TH ST
LE SUEUR MN
56058-2203
US

IV. Provider business mailing address

1025 MARSH ST
MANKATO MN
56001-4752
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-6299
  • Fax:
Mailing address:
  • Phone: 507-625-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37244
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: