Healthcare Provider Details

I. General information

NPI: 1558082560
Provider Name (Legal Business Name): ELENA LUU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9645 GROVE CIR N STE 200
MAPLE GROVE MN
55369-2684
US

IV. Provider business mailing address

9645 GROVE CIR N STE 200
MAPLE GROVE MN
55369-2684
US

V. Phone/Fax

Practice location:
  • Phone: 763-201-8191
  • Fax: 763-201-8192
Mailing address:
  • Phone: 763-201-8191
  • Fax: 763-201-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: