Healthcare Provider Details

I. General information

NPI: 1083278436
Provider Name (Legal Business Name): ALEXI DEE LINDQUIST PA-C PHYSICIAN ASSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXI DEE BOPRAY PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 12/29/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 EAGAN WOODS DR.
EAGAN MN
55121
US

IV. Provider business mailing address

2090 WOODWINDS DR.
WOODBURY MN
55125
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5142
  • Fax: 651-968-5903
Mailing address:
  • Phone: 651-968-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number13010
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13010
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: