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Individual

THERESA M WOLLAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3550 LABORE RD STE 7, VADNAIS HEIGHTS, MN 55110-5113
(651) 766-0520
(651) 766-9451
Mailing address
2025 SLOAN PL STE 35, SAINT PAUL, MN 55117-2092
(651) 772-1572
(651) 772-1889

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32793
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
584098800
MN
Enumeration date
08/01/2006
Last updated
11/21/2019
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