Healthcare Provider Details

I. General information

NPI: 1083296123
Provider Name (Legal Business Name): ALESSANDRA PANTANO ORTHEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 7TH ST W
SAINT PAUL MN
55102-3828
US

IV. Provider business mailing address

4325 CHOWEN AVE S UNIT 1
MINNEAPOLIS MN
55410-1303
US

V. Phone/Fax

Practice location:
  • Phone: 651-758-9500
  • Fax:
Mailing address:
  • Phone: 612-600-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62623
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14256
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: