Healthcare Provider Details

I. General information

NPI: 1972070019
Provider Name (Legal Business Name): ANA ROSE BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA ROSE ZDECHLIK

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

542 TOMLYN AVE
SHOREVIEW MN
55126-6013
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-2800
  • Fax: 763-581-2801
Mailing address:
  • Phone: 651-500-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12826
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: