Provider Demographics
NPI:1770872095
Name:WALSH JAHNKE, RAQUEL KAY (DO, MBA)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:KAY
Last Name:WALSH JAHNKE
Suffix:
Gender:F
Credentials:DO, MBA
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:KAY
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MBA
Mailing Address - Street 1:347 PIERCE ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2511
Mailing Address - Country:US
Mailing Address - Phone:612-817-1696
Mailing Address - Fax:
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-235-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61231207ZB0001X, 207ZH0000X, 207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program