Healthcare Provider Details

I. General information

NPI: 1003743857
Provider Name (Legal Business Name): BRENDA BAKER PAC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 2ND ST STE 200-1538
MINNEAPOLIS MN
55401-2513
US

IV. Provider business mailing address

330 S 2ND ST STE 200-1538
MINNEAPOLIS MN
55401-2513
US

V. Phone/Fax

Practice location:
  • Phone: 612-876-2775
  • Fax: 612-808-1815
Mailing address:
  • Phone: 612-876-2775
  • Fax: 612-808-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDA JOY BAKER
Title or Position: OWNER
Credential: PAC
Phone: 952-200-5238