Healthcare Provider Details

I. General information

NPI: 1073071635
Provider Name (Legal Business Name): EMMA REESE DOLPHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 W 98TH ST
MINNEAPOLIS MN
55437-2040
US

IV. Provider business mailing address

5750 JOHNSTON ST STE 205
LAFAYETTE LA
70503-5345
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax: 337-943-0846
Mailing address:
  • Phone: 337-991-9276
  • Fax: 337-943-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13034
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: