Provider Demographics
NPI:1538915483
Name:WESSELS, BRYANNA (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:
Last Name:WESSELS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CENTRAL AVE S
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-1123
Mailing Address - Country:US
Mailing Address - Phone:320-983-9010
Mailing Address - Fax:
Practice Address - Street 1:190 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1123
Practice Address - Country:US
Practice Address - Phone:320-983-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily