Healthcare Provider Details

I. General information

NPI: 1184217622
Provider Name (Legal Business Name): REBECCA LYNN RASCHE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST STE 401
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-0200
  • Fax: 612-863-0235
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13608
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: