Individual
MRS. WENDY AMANDA GRAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
415 JEFFERSON ST NORTH, WADENA, MN 56482
(218) 631-3510
(218) 631-7496
Mailing address
13436 COUNTY ROAD 101, WADENA, MN 56482
(218) 632-5989
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R1540705
MN
Other
Enumeration date
09/01/2006
Last updated
07/08/2007
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