Individual
PHYLLIS C WIENER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
WHCNP
Contact information
Practice address
1200 LAGOON AVE, MINNEAPOLIS, MN 55408-2077
(612) 823-6300
Mailing address
4028 ELLIOT AVE, MINNEAPOLIS, MN 55407-3147
(612) 822-1548
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R1017050
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07-14658
MEDICA
—
01
—
1017710
PREFERRED ONE
—
01
—
1075705
AMERICA'S PPO (ARAZ)
—
01
—
142730
UCARE
—
01
—
28721
SIOUX VALLEY HEALTH PLAN
—
01
—
5K166WI
BCBS MN
MN
01
—
HP17896
HEALTH PARTNERS
—
Enumeration date
01/25/2006
Last updated
07/08/2007
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