Individual
MRS. MARY THERESA WILD CREA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5975 CARMEN AVE, INVER GROVE HEIGHTS, MN 55076-4416
(651) 455-9697
(651) 455-2012
Mailing address
1286 RAYMOND AVE, SAINT PAUL, MN 55108-1820
(651) 455-9697
(651) 455-2012
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
38767
MN
Other
Enumeration date
07/29/2005
Last updated
07/08/2007
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