Healthcare Provider Details

I. General information

NPI: 1679437370
Provider Name (Legal Business Name): MONICA RAMONA VAN WATERMEULEN FALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CARLSON ST # 100
MARSHALL MN
56258-2626
US

IV. Provider business mailing address

1521 CARLSON ST # 100
MARSHALL MN
56258-2626
US

V. Phone/Fax

Practice location:
  • Phone: 507-401-7268
  • Fax:
Mailing address:
  • Phone: 507-401-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: