Healthcare Provider Details

I. General information

NPI: 1033886957
Provider Name (Legal Business Name): ASHLEY HEPPNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR
ARDEN HILLS MN
55112-6966
US

IV. Provider business mailing address

5815 DREW AVE N
BROOKLYN CENTER MN
55429-2509
US

V. Phone/Fax

Practice location:
  • Phone: 651-787-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13860
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: