Healthcare Provider Details

I. General information

NPI: 1104414242
Provider Name (Legal Business Name): RACHEL OEFFLING PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HUNDERTMARK RD STE 120
CHASKA MN
55318-1195
US

IV. Provider business mailing address

1513 W SHORE DR
BUFFALO MN
55313-5639
US

V. Phone/Fax

Practice location:
  • Phone: 952-856-4001
  • Fax:
Mailing address:
  • Phone: 954-262-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14240
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: