MRS. KISUK BAE WIRTZ
NPI 1457672800
Licensed Practical Nurse in Detroit Lakes, MN
- Individual
- Female
- Licensed Practical Nurse
About KISUK WIRTZ
This page provides the complete NPI Profile along with additional information for Kisuk Wirtz, a provider established in Detroit Lakes, Minnesota with a medical specialization in Licensed Practical Nurse. The healthcare provider is registered in the NPI registry with number 1457672800 assigned on June 2010. The practitioner's primary taxonomy code is 164W00000X with license number L48823-7 (MN). The provider is registered as an individual and her NPI record was last updated 16 years ago.
- NPI
- 1457672800 Verify this NPI
- Provider Name
- MRS. KISUK BAE WIRTZ
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 114 FRAZEE ST E 47854 SWISS LANE DETROIT LAKES, MN 56501
- Location Phone
- (218) 573-3898
- Mailing Address
- PO BOX 884 47854 SWISS LANE PONSFORD, MN 56575
- Mailing Phone
- (218) 573-3898
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 06-21-2010
- Last Update Date
- 06-21-2010
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Licensed Practical Nurse
- Taxonomy Code
- 164W00000X
- Type
- Nursing Service Providers
- License No.
- L48823-7
- License State
- MN
- Taxonomy Description
- A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1457672800, enumerated as an "individual" on June 21, 2010.
The provider is located at 114 FRAZEE ST E 47854 SWISS LANE DETROIT LAKES, MN 56501 and the phone number is (218) 573-3898.
Licensed Practical Nurse with taxonomy code 164W00000X.
