Healthcare Provider Details

I. General information

NPI: 1265485916
Provider Name (Legal Business Name): HEATHER LUNNING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SHERMAN ST STE 100
SAINT PAUL MN
55102
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 110N
SAINT PAUL MN
55114-2001
US

V. Phone/Fax

Practice location:
  • Phone: 651-251-5500
  • Fax: 651-251-5555
Mailing address:
  • Phone: 651-602-5309
  • Fax: 651-222-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9248
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: