Healthcare Provider Details

I. General information

NPI: 1437163060
Provider Name (Legal Business Name): MARY TERESA STETZEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 FORD PKWY
SAINT PAUL MN
55116-1923
US

IV. Provider business mailing address

1965 FORD PKWY
SAINT PAUL MN
55116-1923
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-5509
  • Fax:
Mailing address:
  • Phone: 651-696-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR 094122-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: