Provider Demographics
NPI:1588163968
Name:POPPE, STEPHANIE DARLENE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DARLENE
Last Name:POPPE
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:544 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2106
Mailing Address - Country:US
Mailing Address - Phone:320-321-1181
Mailing Address - Fax:
Practice Address - Street 1:544 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2106
Practice Address - Country:US
Practice Address - Phone:320-321-1181
Practice Address - Fax:320-321-1388
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR45232363LF0000X
MN7911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily