Healthcare Provider Details

I. General information

NPI: 1831858901
Provider Name (Legal Business Name): STEPHANIE SPINOLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/24/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N STE 100
SAINT PAUL MN
55102-2332
US

IV. Provider business mailing address

310 SMITH AVE N STE 100
SAINT PAUL MN
55102-2332
US

V. Phone/Fax

Practice location:
  • Phone: 651-251-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13946
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: