Healthcare Provider Details

I. General information

NPI: 1518877349
Provider Name (Legal Business Name): ETHAN ATOR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 FRANCE AVE S
EDINA MN
55435-2104
US

IV. Provider business mailing address

14800 99TH AVE N APT 411
MAPLE GROVE MN
55369-7584
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number5705
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: