Healthcare Provider Details

I. General information

NPI: 1821276148
Provider Name (Legal Business Name): ROBBIN DALE GHERE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 05/19/2022
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20795 KEOKUK AVE
LAKEVILLE MN
55044-6004
US

IV. Provider business mailing address

PO BOX 43 MR 10202
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-0200
  • Fax: 952-428-0399
Mailing address:
  • Phone: 612-262-1166
  • Fax: 612-262-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10388
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: