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Minnesota Uniform Credentialing Application Initial Physician/Dentist/Allied Health Professional Applicant Name (as shown on your state license):___ LastFirstMiddleSuffixTitleCREDENTIALING CONTACT
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Healthcare professionals in the state of Minnesota who are required to maintain current credentials and licensing.
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Individuals seeking employment or privileges at healthcare facilities that require credentialing.
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The MN Uniform Credentialing Application is a standardized form used by healthcare professionals in Minnesota to apply for credentials with health plans and hospitals.
Healthcare professionals, including physicians, dentists, and other licensed providers who seek to practice in Minnesota and are applying for credentials with health plans or facilities are required to file this application.
To fill out the MN Uniform Credentialing Application, applicants should gather their personal, educational, and professional information, complete each section of the form accurately, and submit any required supporting documents as specified in the instructions.
The purpose of the MN Uniform Credentialing Application is to streamline the credentialing process for healthcare providers, ensuring consistency and efficiency when applying for credentials with various health care organizations.
The application must report personal identification information, education, residency training, work history, malpractice history, and any disciplinary actions taken against the provider.
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