Healthcare Provider Details

I. General information

NPI: 1740758176
Provider Name (Legal Business Name): ANA RAE DAUSCHMIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2018
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 MINNESOTA DR STE 310
EDINA MN
55435-5417
US

IV. Provider business mailing address

4100 MINNESOTA DR STE 310
EDINA MN
55435-5417
US

V. Phone/Fax

Practice location:
  • Phone: 952-929-5600
  • Fax: 952-929-5610
Mailing address:
  • Phone: 952-929-5600
  • Fax: 952-929-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12797
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: