Provider Demographics
NPI:1518230432
Name:WAPPULA, CAROL MARIE
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:WAPPULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MCKENZIE AVE
Mailing Address - Street 2:
Mailing Address - City:STRATHCONA
Mailing Address - State:MN
Mailing Address - Zip Code:56759-5903
Mailing Address - Country:US
Mailing Address - Phone:218-781-2791
Mailing Address - Fax:
Practice Address - Street 1:101 E MCKENZIE AVE
Practice Address - Street 2:
Practice Address - City:STRATHCONA
Practice Address - State:MN
Practice Address - Zip Code:56759-5903
Practice Address - Country:US
Practice Address - Phone:218-781-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide