Provider Demographics
NPI:1235137522
Name:WREDE, JANE M (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:WREDE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:DRIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:908 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1631
Mailing Address - Country:US
Mailing Address - Phone:320-269-6435
Mailing Address - Fax:320-269-4494
Practice Address - Street 1:824 N 11TH ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1629
Practice Address - Country:US
Practice Address - Phone:320-269-8877
Practice Address - Fax:320-321-8200
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR136017-6367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN509181100Medicaid