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NPI Code Detail

MEDICARE: REBECCA BRANDT PA C

MEDICARE:   REBECCA  BRANDT  PA C
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
1363A00000XPhysician Assistant9523MN

Other Identifiers

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

General Provider Information

NPI Number : 1558336198
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA BRANDT PA C
Provider Business Mailing Address
First Line : 8100 34TH AVE S
Second Line : 21110Q
City : BLOOMINGTON
State : MN
Zip : 55425-1672
Country : US
Telephone Number : 763-587-4600
Fax Number : 763-587-4615
Provider Business Practice Location Address
First Line : 15245 BLUEBIRD ST NW
Second Line : MAIL STOP 39300A
City : ANDOVER
State : MN
Zip : 55304-3538
Country : US
Telephone Number : 763-587-4600
Fax Number : 763-587-4615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 04/18/2016

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Directions to “ REBECCA BRANDT PA C” Practice Location

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