Healthcare Provider Details

I. General information

NPI: 1043204647
Provider Name (Legal Business Name): RHONDA MARIE WOLFE MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WEDGWOOD RD N
MAPLE GROVE MN
55311-3647
US

IV. Provider business mailing address

6300 WEDGWOOD RD N
MAPLE GROVE MN
55311-3647
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 651-773-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1518546
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: