Healthcare Provider Details

I. General information

NPI: 1417706888
Provider Name (Legal Business Name): KENDALL MARGUERITE LORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 25TH AVE S
MINNEAPOLIS MN
55454-1513
US

IV. Provider business mailing address

615 S 8TH ST APT 608
MINNEAPOLIS MN
55404-7514
US

V. Phone/Fax

Practice location:
  • Phone: 612-330-1399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: