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NPI Code Detail

MEDICARE: THERESA WANLESS

MEDICARE: THERESA WANLESS
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
1374J00000XDoula

General Provider Information

NPI Number : 1720913726
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA WANLESS
Provider Business Mailing Address
First Line : 6319 ROOSEVELT ST
Second Line :
City : DULUTH
State : MN
Zip : 55807-1942
Country : US
Telephone Number : 218-393-6938
Fax Number :
Provider Business Practice Location Address
First Line : 1121 JACKSON ST NE STE 100
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-3051
Country : US
Telephone Number : 218-393-6938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2026
Last Update Date : 06/12/2026

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Directions to “ THERESA WANLESS ” Practice Location

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