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General NPI Number Information
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NPI Number | 1922166966
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Entity Type | Organization
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Legal Business Name | JOYCENE M WALSTROM AND ASSOCIATES INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7671 CENTRAL AVE NE
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City | FRIDLEY
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State | MN
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Zip | 55432-3575
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Country | US
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Telephone | 763-786-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 7671 CENTRAL AVE NE
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City | FRIDLEY
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State | MN
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Zip | 55432-3575
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Country | US
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Telephone | 763-786-8057
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOYCENE M RYAN
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Credential | LADC
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Telephone | 763-786-8067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 300206
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License Number State | MN
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