Healthcare Provider Details

I. General information

NPI: 1194795765
Provider Name (Legal Business Name): WENDY A KOLAND WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E SAINT GERMAIN ST SUITE 100
SAINT CLOUD MN
56304-4649
US

IV. Provider business mailing address

10397 THRUSH ST NW
COON RAPIDS MN
55433-4652
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-9504
  • Fax:
Mailing address:
  • Phone: 763-757-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR1264748
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: