Healthcare Provider Details

I. General information

NPI: 1902632490
Provider Name (Legal Business Name): CONNIE KAY STIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 PARK LN SE
PRESTON MN
55965-2804
US

IV. Provider business mailing address

410 PARK LN SE
PRESTON MN
55965-2804
US

V. Phone/Fax

Practice location:
  • Phone: 507-765-9986
  • Fax: 507-765-9987
Mailing address:
  • Phone: 507-765-9986
  • Fax: 507-765-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR104073-9
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number2370363
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: