Healthcare Provider Details

I. General information

NPI: 1750099636
Provider Name (Legal Business Name): ANDREA JOY WUCHERPFENNIG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 COLBORNE ST S DEPT: 4TH FLOOR THIRD PARTY BILLING
ST PAUL MN
55102
US

IV. Provider business mailing address

360 COLBORNE ST
SAINT PAUL MN
55102-3228
US

V. Phone/Fax

Practice location:
  • Phone: 651-728-7085
  • Fax:
Mailing address:
  • Phone: 651-728-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2372337
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number2529392
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: