Healthcare Provider Details

I. General information

NPI: 1245914530
Provider Name (Legal Business Name): PARKWAY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 SNELLING AVE S
SAINT PAUL MN
55116-3332
US

IV. Provider business mailing address

721 SNELLING AVE S
SAINT PAUL MN
55116-3332
US

V. Phone/Fax

Practice location:
  • Phone: 651-690-1311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY RESCH
Title or Position: PHYSICIAN
Credential: MD
Phone: 612-759-9298