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General NPI Number Information
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NPI Number | 1225994676
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Entity Type | Individual
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Provider Name | JESSICA ANNE WAHL NP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1997 SLOAN PL STE 17
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City | MAPLEWOOD
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State | MN
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Zip | 55117-2051
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Country | US
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Telephone | 651-772-6251
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Fax |
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Provider Business Mailing Address
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Address Line | 2280 LAMPLIGHT DR
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City | WOODBURY
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State | MN
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Zip | 55125-1653
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Country | US
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Telephone | 320-219-3878
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 13590
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License Number State | MN
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