Provider Demographics
NPI:1619948916
Name:MEIERHOFF, MARY A (WHCNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:MEIERHOFF
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE WATERFRONT PLAZA
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-722-5484
Mailing Address - Fax:
Practice Address - Street 1:1001 E CENTRAL ENTRANCE
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5520
Practice Address - Country:US
Practice Address - Phone:218-722-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR057278-7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
07-04528OtherMEDICA
135391OtherUCARE
HP55632OtherHEALTH PARTNERS
1006717OtherPREFERRED ONE
MN395G3MEOtherBCBS MN
MN790342100Medicaid
686271OtherAMERICA'S PPO (ARAZ)