Provider Information for 1942974514
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JACQUELINE WALZ
Sex: Female
NPI: 1942974514
Last Updated: 2021-08-05
Certification Date: 2021-08-05
Certification Date: 2021-08-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1942974514 | ||||||||
| Enumeration Date | 2021-08-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 15544 FINCH AVE APPLE VALLEY, MN 55124-5823 United States Phone: 701-799-8416 | Fax: | ||||||||
| Primary Practice Address | 15544 FINCH AVE APPLE VALLEY, MN 55124-5823 United States Phone: 701-799-8416 | Fax: | ||||||||
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