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Minnesota uniform credentialing application

Minnesota uniform credentialing application 2005-2025

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The document is the Minnesota Uniform Credentialing Application for initial credentialing of physicians, dentists, and allied health professionals. It requires applicants to provide personal information, credentialing contact details, education history, employment history, professional references, and documentation of licenses and certifications. The application includes a checklist of required documents and disclosure questions regarding professional conduct. It emphasizes the importance of accuracy in the information provided and outlines the process for verification by the entity receiving the application.

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Click ‘Get Form’ to open the Minnesota Uniform Credentialing Application in our platform.
Begin by entering your personal data in the designated fields, including your name, date of birth, and contact information. Ensure all entries are clear and legible.
Complete the credentialing contact information section. This includes providing a phone number, fax number, and email address for follow-up communications.
Fill out the education and training sections meticulously. Include dates, institution names, degrees received, and any relevant certifications.
Address any gaps in your employment history by explaining them clearly in the provided sections. Use additional sheets if necessary.
Review the checklist at the end of the application to ensure you have included all required documents before submission.

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Versions	Form popularity	Fillable & printable
2007	4.8 Satisfied (104 Votes)
2005	4.3 Satisfied (48 Votes)
2004	4 Satisfied (55 Votes)

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