WANDA J ETHEN (NPI# 1154365393) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154365393 |
| Entity Type | Individual |
| Full Name | WANDA J ETHEN |
| Credential | MD |
| Practice Address |
4155 County Road 101 N Plymouth MN 55446-2307 |
| Mailing Address |
8170 33rd Ave S Po Box 1309 Mail Stop 21110q Minneapolis MN 55425-4516 |
| Practice Telephone | 9529938900 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-06-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 116865 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS | 160026 | 01 | |
| MO | 203793518 | 05 | |
| RAILROAD MEDICARE | P00223231 | 01 |
| Street Address |
4155 COUNTY ROAD 101 N |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55446-2307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386614709 | Gail T Griffin | Family Medicine | 4155 County Road 101 N, Plymouth, MN 55446 | 2006-01-26 |
| 1740825991 | Kaitlyn Marie Burley | Physical Therapist | 4155 County Road 101 N, Plymouth, MN 55446-2307 | 2019-11-12 |
| 1407414451 | Sari Ruth Abelson | Physical Therapist | 4155 County Road 101 N, Plymouth, MN 55446-2307 | 2019-06-04 |
| 1285086074 | Kaitlin Carol Schultz | Physical Therapist | 4155 County Road 101 N, Plymouth, MN 55446-2307 | 2016-07-06 |
| 1073904306 | Sarah Mugge | Physical Therapist | 4155 County Road 101 N, 2nd Floor, Plymouth, MN 55446-2307 | 2015-02-09 |
| 1699173773 | Park Nicollet Health Care Products | Durable Medical Equipment & Medical Supplies | 4155 County Road 101 N, Plymouth, MN 55446-2307 | 2014-12-05 |
| 1407255318 | Monica Cristine Bertani | Physical Therapist | 4155 County Road 101 N, Plymouth, MN 55446-2307 | 2014-08-15 |
| 1770862534 | Tamara Janousek | Occupational Therapist | 4155 County Road 101 N, Plymouth, MN 55446 | 2011-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114552379 | Molly M Mahoney | Pharmacist | 4110 Juneau Lane N, Plymouth, MN 55446 | 2020-03-09 |
| 1073064804 | Owen Payne Kusick | Student in an Organized Health Care Education/Training Program | 16717 49th Pl N, Plymouth, MN 55446 | 2016-10-17 |
| 1043696214 | Kari Shoemaker | Speech-Language Pathologist | 5855 Cheshire Parkway, Plymouth, MN 55446 | 2015-08-10 |
| 1902206899 | Kathleen E Steensma | Nurse Practitioner | 15700 37th Ave N. #110, Plymouth, MN 55446 | 2014-08-27 |
| 1851715163 | Group Health Plan Inc | Clinic/Center | 5000 Fernbrook Ln N, Plymouth, MN 55446 | 2014-02-06 |
| 1588903009 | Laura Davidson | Physician Assistant | 3365 Plymouth Blvd., Suite 110, Plymouth, MN 55446 | 2013-02-04 |
| 1366680688 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 6025 Shenandoah Ln N, Plymouth, MN 55446 | 2009-01-23 |
| 1205046646 | Merida A Miller | Obstetrics & Gynecology | 4155 Cty Rd 101 N, Plymouth, MN 55446 | 2007-05-23 |
| 1376684746 | West Metro Ophthalmology, Pa | Ophthalmology | 15655 37th Ave N Ste 200, Plymouth, MN 55446 | 2007-02-09 |
| 1952401390 | Grand St Paul Cvs LLC | Pharmacy | 4140 Rd 101 N, Plymouth, MN 55446 | 2006-09-25 |
| Find all providers in zip 55446 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164087474 | Ask Wellness, LLC | Internal Medicine | 118 Long Pond Rd Ste 101, Plymouth, MA 02360-2662 | 2019-05-02 |
| 1306183215 | Russell J Tonkin | Internal Medicine | 131 Windy Ln, Plymouth, VT 05056-4416 | 2013-01-11 |
| 1588923734 | Gregory David Hazergian | Internal Medicine | 40720 Ann Arbor Rd E, Plymouth, MI 48170-4447 | 2012-05-09 |
| 1124331426 | Stephen Andrew Antonucci | Internal Medicine | 46347 Academy Dr, Plymouth, MI 48170-3519 | 2010-07-15 |
| 1871738997 | Rabia Bashir Khan | Internal Medicine | 15535 34th Ave N Ste 100, Plymouth, MN 55447-2170 | 2008-12-03 |
| 1427215433 | Brian Richard Miller | Internal Medicine | 4500 Lanewood Ln N, Plymouth, MN 55446-3432 | 2008-05-19 |
| 1184895849 | Mario De Meireles Md Mhsa PC | Internal Medicine | 9260 Fellows Creek Dr, Plymouth, MI 48170-6354 | 2008-03-20 |
| 1225252786 | William S George | Internal Medicine | 50 Bay Shore Dr, Plymouth, MA 02360-2006 | 2007-04-13 |
| 1124110556 | Stephanie L Marglin | Internal Medicine | 10 Cordage Park Cir Ste 201, Plymouth, MA 02360-7318 | 2006-09-30 |
| 1003843202 | Gregory Joseph Robke | Internal Medicine | 45 Resnik Road, Suite 302, Plymouth, MA 02360 | 2006-06-26 |
| Find all providers in PLYMOUTH | ||||
Please comment or provide details below to improve the information on WANDA J ETHEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.