Provider Demographics
NPI:1932729704
Name:WREH, OWEGIO
Entity Type:Individual
Prefix:
First Name:OWEGIO
Middle Name:
Last Name:WREH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SILVER LAKE RD NW STE 15
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2204
Mailing Address - Country:US
Mailing Address - Phone:651-280-7224
Mailing Address - Fax:651-305-5256
Practice Address - Street 1:1405 SILVER LAKE ROAD SUITE 15
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:651-280-7224
Practice Address - Fax:651-305-5256
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN814889146OtherPCA