Healthcare Provider Details

I. General information

NPI: 1649984584
Provider Name (Legal Business Name): RACHEL DUBBINK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 HAZELWOOD ST STE 200
MAPLEWOOD MN
55109-1243
US

IV. Provider business mailing address

2945 HAZELWOOD ST STE 200
MAPLEWOOD MN
55109-1243
US

V. Phone/Fax

Practice location:
  • Phone: 651-471-9400
  • Fax:
Mailing address:
  • Phone: 651-471-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14599
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: