Individual
KATHRYN J WALLEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 275-3325
Mailing address
8170 33RD AVE S, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9782
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
598401700
—
MN
Enumeration date
06/16/2006
Last updated
07/27/2021
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