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NPI Code Detail

MEDICARE: RACHEL LAUREL WETZSTEON

MEDICARE: RACHEL LAUREL WETZSTEON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1125J00000XDental TherapistDT139MN

General Provider Information

NPI Number : 1063163491
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL LAUREL WETZSTEON
Provider Business Mailing Address
First Line : 5181 161ST ST W APT 332
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-4975
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 114 3RD ST N
Second Line :
City : CANNON FALLS
State : MN
Zip : 55009-2011
Country : US
Telephone Number : 507-263-4501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2022
Last Update Date : 01/18/2022

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Directions to “ RACHEL LAUREL WETZSTEON ” Practice Location

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