Provider Demographics
NPI:1104316942
Name:STOLTZ, CONNIE ANN (CHC CPT)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:ANN
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:CHC CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 73RD ST E
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-4342
Mailing Address - Country:US
Mailing Address - Phone:320-815-3766
Mailing Address - Fax:
Practice Address - Street 1:3837 73RD ST E
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076
Practice Address - Country:US
Practice Address - Phone:320-815-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN811441834174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator