Healthcare Provider Details

I. General information

NPI: 1881698801
Provider Name (Legal Business Name): DEBORAH R OSGOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH R DANIELS PA-C

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 MINNESOTA DR STE 200
BLOOMINGTON MN
55435-5202
US

IV. Provider business mailing address

3601 MINNESOTA DR STE 200
BLOOMINGTON MN
55435-5202
US

V. Phone/Fax

Practice location:
  • Phone: 612-879-1000
  • Fax: 612-879-9116
Mailing address:
  • Phone: 612-879-1000
  • Fax: 612-879-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8942
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: