Individual
STACY MARIE BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Mailing address
PO BOX 43, MINNEAPOLIS, MN 55440-0043
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6040
MN
Other
Enumeration date
07/29/2018
Last updated
10/26/2020
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