Provider Demographics
NPI:1265524136
Name:WIPPLER, GINA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:WIPPLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:TOUMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1555 NORTHWAY DRIVE #100
Mailing Address - Street 2:CENTRACARE CLINIC NORTHWAY FAMILY MEDICINE
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1258
Mailing Address - Country:US
Mailing Address - Phone:320-251-1775
Mailing Address - Fax:320-240-3131
Practice Address - Street 1:1555 NORTHWAY DRIVE #100
Practice Address - Street 2:CENTRACARE CLINIC NORTHWAY FAMILY MEDICINE
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1258
Practice Address - Country:US
Practice Address - Phone:320-251-1775
Practice Address - Fax:320-240-3131
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9761363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN132M4T0OtherBCBS
MN136543600Medicaid
MN0113101OtherMEDICA
MN142448C736OtherUCARE
MN136543600Medicaid
MN0113101OtherMEDICA