Individual
MR. RICHARD JOHN MASTENBROOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
11725 STINSON AVE, CHISAGO CITY, MN 55013-9542
(651) 257-8850
(651) 257-8852
Mailing address
1700 UNIVERSITY AVE W, SAINT PAUL, MN 55104-3727
(516) 232-2002
(651) 326-9635
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AG0714121
MN
Other
Enumeration date
08/10/2014
Last updated
08/11/2022
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