Provider Demographics
NPI:1699543603
Name:WENCL, MADELINE HOPE (PA)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:HOPE
Last Name:WENCL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:HOPE
Other - Last Name:MARASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2069 WATSON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1136
Mailing Address - Country:US
Mailing Address - Phone:763-248-0462
Mailing Address - Fax:
Practice Address - Street 1:4300 MARKET PTE DR STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-767-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant