Healthcare Provider Details

I. General information

NPI: 1902415706
Provider Name (Legal Business Name): VERA BOATENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CAMPUS DR STE 400
PLYMOUTH MN
55441-2659
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-577-7400
  • Fax: 763-236-2650
Mailing address:
  • Phone: 612-262-9000
  • Fax: 612-262-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number8257-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76507-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82215
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: