Healthcare Provider Details

I. General information

NPI: 1164805008
Provider Name (Legal Business Name): HANNAH PRISSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH ELISE YANCEY PA-C

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 NORTHLAND DR
BLOOMINGTON MN
55431-4800
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-8742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2294
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: