Healthcare Provider Details

I. General information

NPI: 1649934159
Provider Name (Legal Business Name): HANNAH FREY-HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FRANCE AVE S STE 200
EDINA MN
55435-2141
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-8671
  • Fax: 952-920-0866
Mailing address:
  • Phone: 952-512-5600
  • Fax: 952-512-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14402
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: