Individual
STEPHANIE COLESTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4848 OTTER LAKE RD, WHITE BEAR LAKE, MN 55110-2902
(651) 399-9144
Mailing address
4848 OTTER LAKE RD, WHITE BEAR LAKE, MN 55110-2902
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
163W0000X- RN
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R 1713231
MN BOARD OF NURSING RN LICENSE
MN
Enumeration date
11/17/2016
Last updated
11/17/2016
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