MEDICARE: SONIA NIKOLAYEVNA RUNKEL 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
2	363A00000X	Physician Assistant	14242	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14242	OTHER	MN	MN PA LICENSE

General Provider Information

NPI Number	:	1164164497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA NIKOLAYEVNA RUNKEL PA

Provider Business Mailing Address
First Line	:	1000 W 140TH ST STE 100
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4835
Country	:	US
Telephone Number	:	952-435-0303
Fax Number	:	952-892-5166

Provider Business Practice Location Address
First Line	:	1000 W. 140TH ST.
Second Line	:	SUITE #100
City	:	BURNSVILLE
State	:	MN
Zip	:	55337
Country	:	US
Telephone Number	:	952-435-0303
Fax Number	:	952-892-5166

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	06/03/2026

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Directions to “ SONIA NIKOLAYEVNA RUNKEL PA” Practice Location

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