Provider Demographics
NPI:1922166966
Name:JOYCENE M WALSTROM AND ASSOCIATES INC
Entity Type:Organization
Organization Name:JOYCENE M WALSTROM AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:763-786-8067
Mailing Address - Street 1:7671 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3575
Mailing Address - Country:US
Mailing Address - Phone:763-786-8057
Mailing Address - Fax:
Practice Address - Street 1:7671 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3575
Practice Address - Country:US
Practice Address - Phone:763-786-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300206261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center