Provider Demographics
NPI:1285794958
Name:WENBERG, MARNY MARIE (PCA)
Entity type:Individual
Prefix:MS
First Name:MARNY
Middle Name:MARIE
Last Name:WENBERG
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 CENTER AVE E
Mailing Address - Street 2:PO BOX #40
Mailing Address - City:CLARA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:89222
Mailing Address - Country:US
Mailing Address - Phone:320-235-4613
Mailing Address - Fax:320-231-9140
Practice Address - Street 1:WOODLAND CENTERS
Practice Address - Street 2:1125 6TH STREET SE
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4675
Practice Address - Country:US
Practice Address - Phone:320-231-9148
Practice Address - Fax:320-231-9140
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant