Healthcare Provider Details

I. General information

NPI: 1598582934
Provider Name (Legal Business Name): MICHELLE ELISE DOERING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 42ND AVE N
NEW HOPE MN
55427-1107
US

IV. Provider business mailing address

8100 42ND AVE N
NEW HOPE MN
55427-1107
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-5700
  • Fax:
Mailing address:
  • Phone: 763-581-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1242358
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: