Provider Demographics
NPI:1235115577
Name:ADEFRIS, WANDA P (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:P
Last Name:ADEFRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:215 RADIO DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2298
Mailing Address - Country:US
Mailing Address - Phone:651-686-6400
Mailing Address - Fax:651-714-1264
Practice Address - Street 1:1875 WOODWINDS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2298
Practice Address - Country:US
Practice Address - Phone:651-686-6400
Practice Address - Fax:651-714-1264
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN37274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
101391OtherHEALTH PARTNERS
MN828818600Medicaid
0702346OtherMEDICA
1006635OtherPREF ONE
36P25ADOtherBCBS
0702346OtherMEDICA
MN160001761Medicare ID - Type Unspecified