Healthcare Provider Details

I. General information

NPI: 1144158155
Provider Name (Legal Business Name): ALYSSA OLSON WEMPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTH RD
MANKATO MN
56001-7046
US

IV. Provider business mailing address

510 E VINE ST
MANKATO MN
56001-6116
US

V. Phone/Fax

Practice location:
  • Phone: 507-389-2147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT183
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: