Individual
MR. EMMANUEL RANDOLPH WHEAGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6248 LAKELAND AVE N, BROOKLYN PARK, MN 55428-2986
(848) 230-1286
Mailing address
6248 LAKELAND AVE N STE 208, BROOKLYN PARK, MN 55428-2989
(848) 230-1286
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W32792257902702
DRIVER'S LICENSE
NJ
Enumeration date
02/13/2020
Last updated
02/13/2020
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