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1548230196

NPI Code Detail

MEDICARE: PHYLLIS C WIENER WHCNP

MEDICARE: PHYLLIS C WIENER WHCNP

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	363LW0102X	Women's Health Nurse Practitioner	R1017050	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1075705	OTHER		AMERICA'S PPO (ARAZ)
2	07-14658	OTHER		MEDICA
3	5K166WI	OTHER	MN	BCBS MN
4	1017710	OTHER		PREFERRED ONE
5	142730	OTHER		UCARE
6	28721	OTHER		SIOUX VALLEY HEALTH PLAN
7	HP17896	OTHER		HEALTH PARTNERS

General Provider Information

NPI Number	:	1548230196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS C WIENER WHCNP

Provider Business Mailing Address
First Line	:	4028 ELLIOT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3147
Country	:	US
Telephone Number	:	612-822-1548
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 LAGOON AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2077
Country	:	US
Telephone Number	:	612-823-6300
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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Directions to “ PHYLLIS C WIENER WHCNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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