Individual
JERRY WAYNE STANKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3555 WILLOW LAKE BLVD, SUITE 240, SAINT PAUL, MN 55110-5131
(651) 770-0110
(651) 770-0134
Mailing address
60 PLATO BLVD E, SUITE 270, SAINT PAUL, MN 55107-1827
(651) 209-1600
(651) 291-9169
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
22442
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
553002400
—
MN
Enumeration date
08/30/2006
Last updated
01/28/2013
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