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General NPI Number Information
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NPI Number | 1124453899
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Entity Type | Individual
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Provider Name | CLAIRE RUSTAD WELO PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 576 BIELENBERG DR STE 250
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City | WOODBURY
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State | MN
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Zip | 55125-1739
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Country | US
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Telephone | 866-821-0281
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 E SHORE DR
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4210
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Country | US
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Telephone | 612-723-8793
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 3258
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License Number State | MN
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