Ethen, Wanda J
Ethen, Wanda J is an sole proprietor health care provider with primary practice located at 4155 County Road 101 N , Plymouth MN 55446-2307. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Ethen, Wanda J can be contacted via phone (952) 993-8900.Contact Information
Primary practice address
4155 County Road 101 N
Plymouth MN 55446-2307
Phone: (952) 993-8900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 116865 | Missouri |
Profile Details
| NPI number | 1154365393 |
|---|---|
| LBN Legal business name | Ethen, Wanda J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 16th, 2006 |
| Last updated | Jun 30th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154365393 | NPPES |
| Other | 160026 | BCBS | |
| Other | P00223231 | BCBS | |
| MEDICAID | 203793518 | BCBS |
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