Healthcare Provider Details

I. General information

NPI: 1164483194
Provider Name (Legal Business Name): MARY ANN HEFFELBOWER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN POLLATSEK PA-C

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 33RD AVE S # MS 21106W
BLOOMINGTON MN
55425
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21106W
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax: 651-254-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9671
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: