MEDICARE: ALYSSA OLSON WEMPEN

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
1	125J00000X	Dental Therapist	DT183	MN

General Provider Information

NPI Number	:	1144158155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA OLSON WEMPEN

Provider Business Mailing Address
First Line	:	510 E VINE ST
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-6116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SOUTH RD
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-7046
Country	:	US
Telephone Number	:	507-389-2147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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