Individual
TARA MICHELLE WYLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17489 DODD BLVD, LAKEVILLE, MN 55044-6506
(952) 428-1020
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15219
MN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
12/17/2024
Last updated
03/21/2025
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