Healthcare Provider Details

I. General information

NPI: 1245910835
Provider Name (Legal Business Name): RYANN MICHELLE KUJAWA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RYANN MICHELLE KUJAWA

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 FRANCE AVE S STE 408
EDINA MN
55435-4549
US

IV. Provider business mailing address

1950 NORTHWESTERN AVE S STE 102
STILLWATER MN
55082-7615
US

V. Phone/Fax

Practice location:
  • Phone: 651-430-3800
  • Fax: 651-430-3827
Mailing address:
  • Phone: 651-430-3800
  • Fax: 651-430-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14595
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: