Individual
JACQUELINE WALZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15544 FINCH AVE, APPLE VALLEY, MN 55124-5823
(701) 799-8416
Mailing address
15544 FINCH AVE, APPLE VALLEY, MN 55124-5823
(701) 799-8416
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
20075
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M714132000
—
MN
Enumeration date
08/05/2021
Last updated
08/05/2021
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