Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Kisuk Bae Wirtz

Individual provider Licensed Practical Nurse · NPI 1457672800

Mrs. Kisuk Bae Wirtz is a Licensed Practical Nurse in Detroit Lakes, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.

Licensed in
MN
In the registry since
2010
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Practice location Address checks out

114 Frazee St E 47854 Swiss Ln
Detroit Lakes, MN 56501-3502
Phone: (218) 573-3898
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Licensed Practical Nurse (primary) Taxonomy 164W00000X · Licence L48823-7 (MN)

Record details

NPI number1457672800
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 21, 2010
Last updated in NPPESJune 21, 2010

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