Individual
MRS. GINA MARIE WIPPLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1555 NORTHWAY DRIVE #100, CENTRACARE CLINIC NORTHWAY FAMILY MEDICINE, ST CLOUD, MN 56303-1258
(320) 251-1775
(320) 240-3131
Mailing address
1555 NORTHWAY DRIVE #100, CENTRACARE CLINIC NORTHWAY FAMILY MEDICINE, ST CLOUD, MN 56303-1258
(320) 251-1775
(320) 240-3131
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9761
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0113101
MEDICA
MN
01
—
132M4T0
BCBS
MN
05
—
136543600
—
MN
01
—
142448C736
UCARE
MN
Enumeration date
09/29/2006
Last updated
03/27/2023
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