Healthcare Provider Details

I. General information

NPI: 1750899209
Provider Name (Legal Business Name): LINDSAY JO MCCAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY JO BOESCHE

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAKE DR E
CHANHASSEN MN
55317-9302
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 952-993-4300
  • Fax: 952-993-4320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: