Provider Demographics
NPI:1447347083
Name:CARROLL, WENDY L (PA-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8559 EDINBROOK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3747
Mailing Address - Country:US
Mailing Address - Phone:763-425-1888
Mailing Address - Fax:
Practice Address - Street 1:8559 EDINBROOK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3747
Practice Address - Country:US
Practice Address - Phone:612-374-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP26994Medicare UPIN