Provider Demographics
NPI:1730191990
Name:DOELE, ESTHER MARIE (C-FNP)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:MARIE
Last Name:DOELE
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:MARIE
Other - Last Name:WIELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-829-2861
Mailing Address - Fax:507-223-7465
Practice Address - Street 1:14133 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8462
Practice Address - Country:US
Practice Address - Phone:218-454-5802
Practice Address - Fax:507-223-7465
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1073913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN807960900Medicaid
500003164Medicare ID - Type Unspecified
MN807960900Medicaid