Individual
MADELINE WALLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3931 LOUISIANA AVE S, SAINT LOUIS PARK, MN 55426-4375
(952) 993-3200
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-15466
NC
363A00000X
Physician Assistant
Primary
15758
MN
Other
Enumeration date
08/25/2021
Last updated
06/11/2026
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