Individual
STACY JO UPTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28115 LILY ST NW, ISANTI, MN 55040-5995
(763) 238-9261
Mailing address
28115 LILY ST NW, ISANTI, MN 55040-5995
(763) 238-9261
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
AS779871
MN
Other
Enumeration date
07/11/2024
Last updated
07/11/2024
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