Provider Demographics
NPI:1245241629
Name:WODRICH, BETH E (NP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:WODRICH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2025 SLOAN PL STE 35
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2092
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:8325 CITY CENTRE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3605
Practice Address - Country:US
Practice Address - Phone:651-731-0859
Practice Address - Fax:651-731-0976
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNCNP0984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN630318800Medicaid
MN630318800Medicaid