Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 31819 | MN |
NPI | 1184613929 |
---|---|
Provider Name | Dr. Wade Carl Wernecke |
First Address | Hot Springs, AR 71913-6406 |
Second Address | Hot Springs, AR 71913-6406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053502800 | (05) | MN |
2M151WE | BCBS (01) | MN |
5H0526972 | MEDICARELINKED (01) | AR |
A95312 | (02) | MN |
HP31594 | HEALTHPARTNERS (01) | MN |