JESSICA JERICH WETTERLIN (NPI# 1245529379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245529379 |
| Entity Type | Individual |
| Full Name | JESSICA JERICH WETTERLIN |
| Credential | M.D. |
| Practice Address |
435 Phalen Blvd Ms 51103c St. Paul MN 55130 |
| Mailing Address |
8170 33rd Ave S Ms 21110q Bloomington MN 55425-4516 |
| Practice Telephone | 6512548500 |
| Mailing Telephone | 6512548500 |
| Mailing Fax Number | 6512548504 |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2019-11-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 1245529379 | IL | Allopathic & Osteopathic Physicians |
| Y | 208800000X | Urology | 66275 | MN | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 4301112391 | MI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 577 Michigan Ave Ste 201, Holland, MI 49423 | (616) 392-1816 | 6163921292 |
| Street Address |
435 PHALEN BLVD MS 51103C |
| City | ST. PAUL |
| State | MN |
| Zip Code | 55130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457352650 | Joanne E Heerwald | Nurse Anesthetist, Certified Registered | 435 Phalen Blvd, St. Paul, MN 55130 | 2005-08-10 |
| 1801072830 | Daniel J Virnig | Internal Medicine | 435 Phalen Blvd, Ms 51103b, Healthpartners Specialty Center 435, St. Paul, MN 55130-5302 | 2008-01-22 |
| 1447221361 | Randy S Twito | Orthopaedic Surgery | 435 Phalen Blvd, Healthpartners Speciality Center 435, St. Paul, MN 55130-5302 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904587 | Confident Care LLC | In Home Supportive Care | 1040 Arkwright Street, Saint Paul, MN 55130 | 2018-09-01 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1427394501 | Zongxee Lee | Registered Nurse | 1072 Payne Ave, St. Paul, MN 55130 | 2012-12-18 |
| 1740532753 | One Stop Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 1049 Payne Ave Suite C, St Paul, MN 55130 | 2012-10-15 |
| 1689923997 | Alexis Simmons | Counselor | 402 University Ave East, Suite A-127, Saint Paul, MN 55130 | 2012-08-31 |
| 1689804064 | Group Health Plan, Inc. | Durable Medical Equipment & Medical Supplies | 537 Phalen Blvd, Saint Paul, MN 55130 | 2009-07-21 |
| 1477756534 | Chad Everett Christensen | Chiropractor | 1073 Payne Ave, Saint Paul, MN 55130 | 2007-06-07 |
| 1922219021 | Qwik Urgent Care Clinic | Family Medicine | 1239 Payne Avenue, Saint Paul, MN 55130 | 2007-05-24 |
| 1275743981 | Yia Vang | Technician | 1100 Arkwright St., St. Paul, MN 55130 | 2007-05-23 |
| Find all providers in zip 55130 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255421129 | Parker M Eberwein | Urology | 435 Phalen Blvd - Ms 51103c, Healthpartners Specialty Center 435, St. Paul, MN 55130-5302 | 2006-10-13 |
| 1891989422 | Stephen J Lukasewycz | Urology | 435 Phalen Blvd - Ms 51103c, Healthpartners Specialty Center 435, St. Paul, MN 55130-5302 | 2007-08-27 |
| 1821176629 | Leila Tabibian | Urology | 435 Phalen Blvd - Ms 51103c, Healthpartners Specialty Center 435, St. Paul, MN 55130-5302 | 2006-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255939286 | Joseph Marconni Sewell Araya | Urology | 11920 Baypoint Dr, Burnsville, MN 55337-3367 | 2020-10-12 |
| 1922599737 | Subodh Kumar Regmi | Urology | Department of Urology, University of Minnesoata, 420 Delaware St S.e., Mmc 394, Minneapolis, MN 55455 | 2018-05-29 |
| 1700281953 | Centracare Clinic | Urology | 2351 Connecticut Ave S, Suite 200, Centracare Clinic- Adult & Pediatric Urology, Sartell, MN 56377-2477 | 2014-10-30 |
| 1154734127 | Abhinav Khanna | Urology | 200 First Street Nw, Rochester, MN 55905-0001 | 2014-06-08 |
| 1427476662 | Khushabu Kasabwala | Urology | 420 Delaware St. S. E., Mmc 394, Minneapolis, MN 55455 | 2014-04-04 |
| 1518302181 | Daniel Liberman | Urology | 420 Delaware Stre Se, Suite B435, Institute for Prostrate and Urologic Cancers, Minneapolis, MN 55455-0341 | 2013-05-08 |
| 1386981637 | Urology Associates, Ltd. | Urology | 244 7th Street North, Mora, MN 55051 | 2013-01-07 |
| 1831445691 | Urology Associates, Ltd. | Urology | 111 Hundertmark Rd Ste 410, 212 Medical Building, Chaska, MN 55318-1458 | 2012-07-31 |
| 1841590593 | Hakim Medical Enterprises, P.a. | Urology | 2963 Fairchild Ave, Wayzata, MN 55391-2956 | 2010-10-28 |
| 1164747085 | Joseph Robert Nelson Zabell | Urology | 6363 France Ave S Ste 500, Edina, MN 55435-2135 | 2010-04-03 |
| Find all providers with the same taxonomy | ||||
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| 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.