Healthcare Provider Details

I. General information

NPI: 1780738385
Provider Name (Legal Business Name): WAYNE ANTHONY ARNZEN L.P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 PIKE LAKE RD
GRAND MARAIS MN
55604-2230
US

IV. Provider business mailing address

342 PIKE LAKE RD
GRAND MARAIS MN
55604-2230
US

V. Phone/Fax

Practice location:
  • Phone: 218-387-1098
  • Fax: 218-387-1098
Mailing address:
  • Phone: 218-387-1098
  • Fax: 218-387-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 1185
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: