Individual
MR. NICHOLAS GENE STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
400 ANNANDALE BLVD, ANNANDALE, MN 55302-3141
(651) 259-3850
Mailing address
1044 15TH AVE S, SAINT CLOUD, MN 56301-5208
(320) 224-3100
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
710329
MN
Other
Enumeration date
12/14/2017
Last updated
03/17/2018
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