Healthcare Provider Details

I. General information

NPI: 1023502879
Provider Name (Legal Business Name): TAYLOR MARIE WOLKE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 HUDSON RD #1K21
ST PAUL MN
55119
US

IV. Provider business mailing address

9591 FOXFORD RD
CHANHASSEN MN
55317-8682
US

V. Phone/Fax

Practice location:
  • Phone: 651-737-7022
  • Fax:
Mailing address:
  • Phone: 651-470-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3568
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: