Provider Demographics
NPI:1922324474
Name:WENZEL, TERA ANNE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TERA
Middle Name:ANNE
Last Name:WENZEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:TERA
Other - Middle Name:ANNE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:15330 42ND ST NE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-9214
Mailing Address - Country:US
Mailing Address - Phone:320-345-1776
Mailing Address - Fax:
Practice Address - Street 1:3701 12TH ST N #202
Practice Address - Street 2:
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-258-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR177181-7367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN430007107Medicare PIN