NPI 1821059692

Stacey L Ko, PAC

Practitioner Physician Assistant Cottage Grove, MN

Practice location

Address: 7500 80th St S, Suite 100 - Ms 34624a Healthpartners Cottage Grove Clinic, Cottage Grove, MN 55016-3008
Phone: (651) 415-4100
Fax: (651) 415-4101
Mailing address: 8170 33rd Ave S Ms21110q, Minneapolis, MN 55425-4516

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 9655 (MN)

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Registry record

NPI: 1821059692
Entity type: Individual
Sex (as registered): Female
NPI issued: 31 Mar 2006
Record last updated: 11 Mar 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.