Individual
ABBY K WIBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2200 UNIVERSITY AVE W, SUITE 120, SAINT PAUL, MN 55114-1839
(612) 871-1145
(612) 870-5491
Mailing address
PO BOX 14909, MINNEAPOLIS, MN 55414-0909
(612) 871-1145
(612) 870-5491
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R15678805
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R156788-5
LICENSE
MN
Enumeration date
09/27/2010
Last updated
10/22/2014
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