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General NPI Number Information
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NPI Number | 1063347425
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Entity Type | Individual
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Provider Name | KAYLA WIMMER
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Gender | Female
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 2450 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1450
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Country | US
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Telephone | 320-339-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 9566 BUCHANAN ST NE
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City | BLAINE
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State | MN
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Zip | 55434-3417
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Country | US
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Telephone | 320-339-1177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 2487197
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License Number State | MN
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