Provider Demographics
NPI:1043204647
Name:WOLFE, RHONDA MARIE (MSN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:MARIE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEDGWOOD RD N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3647
Mailing Address - Country:US
Mailing Address - Phone:651-773-4958
Mailing Address - Fax:
Practice Address - Street 1:6300 WEDGWOOD RD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-3647
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1518546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN384389100Medicaid
500002688Medicare ID - Type Unspecified
Q21783Medicare UPIN
MN500002688Medicare PIN