Individual
BRIANNA DIANE WUERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4140 RICHARD AVE STE 200, HERMANTOWN, MN 55811-3309
(218) 514-5230
Mailing address
4250 AUGUSTA LN, EAGAN, MN 55123-2071
(651) 528-9681
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588993091
—
MN
Enumeration date
03/12/2021
Last updated
04/18/2022
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