Individual
MS. CAYLYNN ANN WALLACE-MARCELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, CPNP
Contact information
Practice address
8441 WAYZATA BLVD, STE 140, GOLDEN VALLEY, MN 55426-1366
(651) 769-6300
(651) 769-6349
Mailing address
2497 7TH AVENUE E, STE 108, NORTH ST PAUL, MN 55109-2946
(651) 769-6437
(651) 769-6599
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
955
MN
363LP0200X
Pediatric Nurse Practitioner
R180936-5
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1809365
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861558835
—
MN
Enumeration date
12/27/2006
Last updated
09/13/2022
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