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Individual

MS. CHARLOTTE LOUISE STACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.N., CNS

Contact information

Practice address
882 SW 15TH ST., FOREST LAKE, MN 55025-1331
(651) 464-2194
(651) 464-5744
Mailing address
573 N DAY RD, SAINT CROIX FALLS, WI 54024-9454
(715) 483-9688
(651) 464-5744

Taxonomy

Speciality
Code
Description
License number
State
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
R0917850
MN

Other

Enumeration date
11/07/2006
Last updated
07/08/2007
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