Healthcare Provider Details

I. General information

NPI: 1609284702
Provider Name (Legal Business Name): COLLEEN WHERLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MMC485
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC485
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-2472
  • Fax: 612-624-6645
Mailing address:
  • Phone: 612-625-2472
  • Fax: 612-624-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: