Provider Demographics
NPI:1245544881
Name:GIRTZ, WILMA RAE
Entity type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:RAE
Last Name:GIRTZ
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 1:13508 190TH ST
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-3295
Mailing Address - Country:US
Mailing Address - Phone:218-732-5959
Mailing Address - Fax:
Practice Address - Street 1:13508 190TH ST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-3295
Practice Address - Country:US
Practice Address - Phone:218-732-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10369781CFC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care