Provider Demographics
NPI:1164092359
Name:ZITZLOFF, WENDY MARIE (ACNP AG)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:ZITZLOFF
Suffix:
Gender:F
Credentials:ACNP AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 107TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-6333
Mailing Address - Country:US
Mailing Address - Phone:320-423-1081
Mailing Address - Fax:
Practice Address - Street 1:1350 107TH AVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-6333
Practice Address - Country:US
Practice Address - Phone:320-423-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1990193363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine