Healthcare Provider Details

I. General information

NPI: 1619948916
Provider Name (Legal Business Name): MARY A MEIERHOFF WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E CENTRAL ENTRANCE SUITE 200
DULUTH MN
55811-5520
US

IV. Provider business mailing address

ONE WATERFRONT PLAZA
DULUTH MN
55802
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-0833
  • Fax:
Mailing address:
  • Phone: 218-722-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR057278-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: