Jerry Wayne Stanke
Dermatologist
3555 Willow Lake Blvd Suite 240
Saint Paul
, Minnesota 55110-5131
Jerry Wayne Stanke
Dermatologist
3555 Willow Lake Blvd Suite 240
Saint Paul
, Minnesota 55110-5131
(651) 291-9169
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Jerry Wayne Stanke
- 60 Plato Blvd E Suite 270
- Saint Paul, MN
- Zip : 55107-1827
- Fax : (651) 291-9169
- Phone : (651) 209-1600
Second Address
- Jerry Wayne Stanke
- 3555 Willow Lake Blvd Suite 240
- Saint Paul, MN
- Zip : 55110-5131
- Fax : (651) 770-0134
- Phone : (651) 770-0110
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 22442 | MN |
National Provider Identifier
| NPI | 1043329220 |
|---|---|
| Provider Name | Jerry Wayne Stanke |
| First Address | Saint Paul, MN 55107-1827 |
| Second Address | Saint Paul, MN 55110-5131 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/08/2006 |
| Last Update Date | 28/01/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 553002400 | (05) | MN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.