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Individual
STEPHANIE JO HATLESTAD
Active
Individual
STEPHANIE JO HATLESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2837
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
087H8HA
BLUE CROSS INDIVIDUAL ID
MN
01
—
1024610
PREFFERED ONE ID
MN
01
—
6B478OR
BLUE CROSS GROUP ID
MN
Enumeration date
01/25/2007
Last updated
07/31/2014
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