Provider Demographics
NPI:1649005521
Name:DRAGONFLY MENOPAUSE MINNESOTA PLLC
Entity type:Organization
Organization Name:DRAGONFLY MENOPAUSE MINNESOTA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-240-8654
Mailing Address - Street 1:2081 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9669
Mailing Address - Country:US
Mailing Address - Phone:612-240-8654
Mailing Address - Fax:
Practice Address - Street 1:8951 CROSSROADS BLVD STE 214
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-7001
Practice Address - Country:US
Practice Address - Phone:952-522-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty