Provider Demographics
NPI:1174161723
Name:MARY WUEBBEN WELLNESS
Entity type:Organization
Organization Name:MARY WUEBBEN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-321-4341
Mailing Address - Street 1:6709 S MINNESOTA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2593
Mailing Address - Country:US
Mailing Address - Phone:605-271-1020
Mailing Address - Fax:605-271-2277
Practice Address - Street 1:6709 S MINNESOTA AVE STE 205
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2593
Practice Address - Country:US
Practice Address - Phone:605-271-1020
Practice Address - Fax:605-271-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty