Healthcare Provider Details

I. General information

NPI: 1790579530
Provider Name (Legal Business Name): ADRIENNE WOJCIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6753 COUNTY ROAD 35 NW
MAPLE LAKE MN
55358-2609
US

IV. Provider business mailing address

6753 COUNTY ROAD 35 NW
MAPLE LAKE MN
55358-2609
US

V. Phone/Fax

Practice location:
  • Phone: 763-370-9959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: