Healthcare Provider Details

I. General information

NPI: 1013070952
Provider Name (Legal Business Name): VICKI THOMSON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 FRANCE AVE S
EDINA MN
55435-4535
US

IV. Provider business mailing address

7025 FRANCE AVE S STE 100
EDINA MN
55435-4215
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7337
  • Fax: 952-927-8610
Mailing address:
  • Phone: 952-927-7337
  • Fax: 952-927-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number1101
License Number StateMN

VIII. Authorized Official

Name: DR. VICKI THOMSON
Title or Position: OWNER
Credential: MD
Phone: 952-927-7337