Individual
GERALD WAYNE HENRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
49725 COUNTY 83, STAPLES, MN 56479-5280
(218) 894-1515
(218) 894-8767
Mailing address
49725 COUNTY 83, STAPLES, MN 56479-5280
(218) 894-1515
(218) 894-8767
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24069
MN
Other
Enumeration date
10/25/2005
Last updated
02/12/2010
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