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NPI Code Detail

MEDICARE: MACKENZIE L EITER PA-C

MEDICARE: MACKENZIE L EITER 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 Assistant14485MN

General Provider Information

NPI Number : 1730711417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE L EITER PA-C
Provider Business Mailing Address
First Line : 720 WASHINGTON AVE SE STE 200
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-2924
Country : US
Telephone Number : 612-884-0600
Fax Number :
Provider Business Practice Location Address
First Line : 500 HARVARD ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-0363
Country : US
Telephone Number : 612-273-8383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2020
Last Update Date : 06/05/2026

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Directions to “ MACKENZIE L EITER PA-C” Practice Location

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