Provider Demographics
NPI:1417603671
Name:WIMMER, NATALIE ELISE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ELISE
Last Name:WIMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 BENSON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3162
Mailing Address - Country:US
Mailing Address - Phone:507-358-8139
Mailing Address - Fax:
Practice Address - Street 1:2221 FORD PKWY STE 350
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3837
Practice Address - Country:US
Practice Address - Phone:800-336-5973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional