Provider Demographics
NPI:1225238900
Name:WENZEL, ABBY LOUISE (CRNP)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:LOUISE
Last Name:WENZEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAIN STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2912
Mailing Address - Country:US
Mailing Address - Phone:612-326-7575
Mailing Address - Fax:612-454-2430
Practice Address - Street 1:540 E 1ST ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1600
Practice Address - Country:US
Practice Address - Phone:952-442-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402151363LP0808X
PASP009464363LP0808X
MN6287363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1225238900Medicaid
NY04763420Medicaid