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Individual
DR. GWEN ELISE WAGSTROM HALAAS
Active
Individual
DR. GWEN ELISE WAGSTROM HALAAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27862
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069904
—
MT
01
—
01-08658
MEDICA CHOICE & PRIMARY
MN
01
—
1000627
PREFERRED ONE
MN
01
—
100518
UCARE
MN
01
—
2057381
ARAZ
MN
01
—
428R9HA
BCBS
MN
01
—
HP10534
HEALTHPARTNERS
MN
Enumeration date
07/07/2006
Last updated
07/09/2007
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