Provider Demographics
NPI:1194795765
Name:KOLAND, WENDY A (WHCNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:KOLAND
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10397 THRUSH ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4652
Mailing Address - Country:US
Mailing Address - Phone:763-757-7640
Mailing Address - Fax:
Practice Address - Street 1:451 E SAINT GERMAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-4649
Practice Address - Country:US
Practice Address - Phone:320-252-9504
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1264748363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1025141OtherPREFERRED ONE
2083907OtherAMERICA'S PPO (ARAZ)
MN25A41KOOtherBCBS MN
07-03767OtherMEDICA
115460OtherUCARE
HP20756OtherHEALTH PARTNERS