Healthcare Provider Details

I. General information

NPI: 1316869662
Provider Name (Legal Business Name): VERNESSCIA WALROND LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 OPTUM CIR
EDEN PRAIRIE MN
55344-2503
US

IV. Provider business mailing address

1296 BEAUMONT AVE
TEANECK NJ
07666-4901
US

V. Phone/Fax

Practice location:
  • Phone: 888-445-8745
  • Fax:
Mailing address:
  • Phone: 917-975-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26N07046700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: