Individual
STACEY L KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7500 80TH ST S, SUITE 100 - MS 34624A, HEALTHPARTNERS COTTAGE GROVE CLINIC, COTTAGE GROVE, MN 55016-3008
(651) 415-4100
(651) 415-4101
Mailing address
8170 33RD AVE S, MS21110Q, MINNEAPOLIS, MN 55425-4516
(952) 883-5375
(651) 415-4101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9655
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150112700
—
MN
Enumeration date
03/31/2006
Last updated
03/11/2021
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