Provider Demographics
NPI:1902632490
Name:STIER, CONNIE KAY
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:KAY
Last Name:STIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PARK LN SE
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MN
Mailing Address - Zip Code:55965-2804
Mailing Address - Country:US
Mailing Address - Phone:507-765-9986
Mailing Address - Fax:507-765-9987
Practice Address - Street 1:410 PARK LN SE
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-2804
Practice Address - Country:US
Practice Address - Phone:507-765-9986
Practice Address - Fax:507-765-9987
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR104073-9163WG0600X
MN2370363163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology