Individual
MICHELLE RENEE WARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
5109 36TH AVE N, CRYSTAL, MN 55422-2007
(763) 587-7900
(763) 587-7989
Mailing address
9201 W BROADWAY AVE STE 601, BROOKLYN PARK, MN 55445-1924
(763) 587-7900
(763) 587-7066
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
959621600
—
MN
Enumeration date
07/03/2006
Last updated
11/09/2022
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