Mrs Kisuk Bae Wirtz, is a
Licensed Practical Nurse based in Detroit Lakes, Minnesota. Mrs Kisuk Bae Wirtz is licensed to practice in Minnesota (license number L48823-7) and her current practice location is
114 Frazee St E, 47854 Swiss Lane, Detroit Lakes, Minnesota. She can be reached at her office (for appointments etc.) via phone at
(218) 573-3898.
NPI number for Mrs Kisuk Bae Wirtz is 1457672800 and her current mailing address is Po Box 884, 47854 Swiss Lane, Ponsford, Minnesota. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1457672800.
Provider's Profile
| Full Name | Mrs Kisuk Bae Wirtz |
|---|
| Gender | Female |
|---|
| Speciality | Licensed Practical Nurse |
|---|
| Location | 114 Frazee St E, Detroit Lakes, Minnesota |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1457672800
- Provider Enumeration Date: 06/21/2010
- Last Update Date: 06/21/2010
Medical Identifiers
Medical identifiers for Mrs Kisuk Bae Wirtz such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1457672800 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 164W00000X | Licensed Practical Nurse | L48823-7 (Minnesota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Kisuk Bae Wirtz is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Kisuk Bae Wirtz,
Po Box 884, 47854 Swiss Lane,
Ponsford, MN 56575
Ph: (218) 573-3898 | Mrs Kisuk Bae Wirtz,
114 Frazee St E, 47854 Swiss Lane,
Detroit Lakes, MN 56501-3502
Ph: (218) 573-3898 |
Reviews and Comments