Wandersee, Stephen C

Wandersee, Stephen C is an individual health care provider with primary practice located at 640 Jackson Street Mc 11102F, St Paul MN 55101-2502. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Wandersee, Stephen C can be contacted via phone (651) 254-3456.

Contact Information

Primary practice address
640 Jackson Street Mc 11102F St Paul MN 55101-2502
Phone: (651) 254-3456
Fax: (651) 254-5216
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 8866 Minnesota

Profile Details

NPI number 1407822554
LBN Legal business name Wandersee, Stephen C
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Mar 24th, 2015 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407822554 NPPES
Minnesota MEDICAID 477448500

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