Healthcare Provider Details

I. General information

NPI: 1851689772
Provider Name (Legal Business Name): JOSEPH M DAUWALTER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST SUITE H2100
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2618 ALDRICH AVE S APT 3
MINNEAPOLIS MN
55408-1369
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-6800
  • Fax: 612-863-6006
Mailing address:
  • Phone: 952-210-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA0611077
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: