Healthcare Provider Details

I. General information

NPI: 1780996629
Provider Name (Legal Business Name): RACHEL K ELBING PA - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

1575 BEAM AVE
MAPLEWOOD MN
55109-1126
US

V. Phone/Fax

Practice location:
  • Phone: 651-635-9173
  • Fax: 651-628-2999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: