Individual
STEPHANIE GRACE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(612) 725-2000
Mailing address
1481 SPRUCE PT, VICTORIA, MN 55386-9577
(612) 209-3772
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
2457727
MN
Other
Enumeration date
08/07/2017
Last updated
08/07/2017
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