Healthcare Provider Details

I. General information

NPI: 1669088225
Provider Name (Legal Business Name): STEPHANIE ANN MCCARNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W STATE HIGHWAY 5
WACONIA MN
55387-1795
US

IV. Provider business mailing address

424 W STATE HIGHWAY 5
WACONIA MN
55387-1795
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-4461
  • Fax: 952-442-1547
Mailing address:
  • Phone: 952-442-4461
  • Fax: 952-442-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14300
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: