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Minnesota uniform credentialing application

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Please do not use abbreviations when completing the application. Please mark all non-applicable sections with N/A. If application is then made to another organization which accepts this Initial Credentialing Application and it has been more than 60 days since the practitioner completed or updated the application the practitioner may do the following Review the application Make any needed modification Sign only one of the attestation blocks below reconfirming that the application is complete t ...

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