Individual
KYLE RUSSELL WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-5014
(612) 630-8270
Mailing address
8050 LAKEBRIDGE LN, VICTORIA, MN 55386-3200
(612) 718-2989
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2188577
MN
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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