Healthcare Provider Details

I. General information

NPI: 1841978863
Provider Name (Legal Business Name): STEGEMAN CONSTRUCTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 STEGEMAN TRL
MORA MN
55051-7446
US

IV. Provider business mailing address

2077 STEGEMAN TRL
MORA MN
55051-7446
US

V. Phone/Fax

Practice location:
  • Phone: 320-515-9021
  • Fax:
Mailing address:
  • Phone: 320-515-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: JESSE STEGEMAN
Title or Position: PROJECT MANAGER
Credential:
Phone: 320-515-9021