Individual
PROF. WALTER THOMAS WENDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
5700 W BROADWAY AVE, CRYSTAL, MN 55428-3568
(651) 464-3966
Mailing address
5700 W BROADWAY AVE, CRYSTAL, MN 55428-3568
(651) 464-3966
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
R-084696-3
MN
163WX0106X
Occupational Health Registered Nurse
R-084696-3
MN
Other
Enumeration date
08/10/2010
Last updated
01/12/2012
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