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General NPI Number Information
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NPI Number | 1578187084
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Entity Type | Individual
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Provider Name | MARCIA WAHL RN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2020
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Last Update Date | 05/31/2020
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Provider Practice Location Address
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Address Line | 2220 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1321
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Country | US
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Telephone | 612-341-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 153 INTERLACHEN RD
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City | HOPKINS
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State | MN
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Zip | 55343-8523
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Country | US
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Telephone | 763-226-3620
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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 | 1238648
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License Number State | MN
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