Healthcare Provider Details

I. General information

NPI: 1356270334
Provider Name (Legal Business Name): SOPHIA SULLIVAN ALMQUIST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11091 JASON AVE NE STE 300
ALBERTVILLE MN
55301-4699
US

IV. Provider business mailing address

11091 JASON AVE NE STE 300
ALBERTVILLE MN
55301-4699
US

V. Phone/Fax

Practice location:
  • Phone: 763-296-8400
  • Fax:
Mailing address:
  • Phone: 763-296-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15781
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: