Individual
MARLYS R WINANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
(651) 241-1515
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42121
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
861321400
—
MN
Enumeration date
03/29/2006
Last updated
03/11/2021
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