| Organization Name: | FOREST LAKE SKIN AND VEIN CLINIC |
| NPI Number: | 1013153907 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LESA RENAE STEGNER (PRESIDENT) |
| Mailing Address: | 280 12th St Sw Suite A Forest Lake |
| State: | MN US |
| Postal Code: | 550253778 |
| Phone Number: | 6514647273 |
| Fax Number: | 6514647969 |
| NPI Enumeration Date: | 12/23/2008 |
| NPI Last Update Date: | 12/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |