Individual
TEIA ROSE WOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2251 CONNECTICUT AVE S, SARTELL, MN 56377-2486
(320) 253-5220
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516
(320) 253-5220
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13223
MN
Other
Enumeration date
10/22/2019
Last updated
11/14/2019
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