MEDICARE: ANNEMARIE A PICKENS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9962	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033176862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNEMARIE A PICKENS PA

Provider Business Mailing Address
First Line	:	8100 34TH AVE S
Second Line	:	MC21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1672
Country	:	US
Telephone Number	:	952-883-7172
Fax Number	:	952-883-5395

Provider Business Practice Location Address
First Line	:	3930 NORTHWOODS DR
Second Line	:	MAIL STOP 32800A
City	:	ARDEN HILLS
State	:	MN
Zip	:	55112-6974
Country	:	US
Telephone Number	:	651-490-6700
Fax Number	:	651-490-6730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/11/2021

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1831160290 — JAMES L EPPERSON MD
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1912978362 — NORMA J CHEESEBROW WHNP
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1154392595 — CLAIRE S NEELY MD
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1063484343 — JUDITH A KUCZENSKI FNP
Practice Location Address:

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1780653949 — JOHN C BUTLER MD
Practice Location Address:

3930 NORTHWOODS DR , MAIL STOP 32800A
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Practice Fax: 651-490-6730

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