Individual
WENDY LAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
(952) 345-3215
(952) 345-8771
Mailing address
5320 W 23RD ST STE 130, ST LOUIS PARK, MN 55416-1670
(952) 345-3215
(952) 345-8771
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
47031
MN
208D00000X
General Practice Physician
Primary
47031
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305477200
—
MN
01
—
47031
MN MEDICAL LICENSE
—
Enumeration date
03/18/2006
Last updated
12/08/2025
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