Individual
MINDY S STAVETEIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 S MINNESOTA ST, CROOKSTON, MN 56716-1808
(218) 281-9100
(218) 281-9189
Mailing address
400 S MINNESOTA STREET, CROOKSTON, MN 56716
(701) 587-6000
(701) 587-6009
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10889
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03M31AN
MN BCBS
MN
01
—
1154509479
MEDICA
—
01
—
30806
ND BCBS
ND
01
—
30806
TRICARE
—
05
—
342440000
—
MN
01
—
NA9481054162
PREFERRED ONE
—
Enumeration date
02/08/2008
Last updated
08/30/2018
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