Healthcare Provider Details

I. General information

NPI: 1053468074
Provider Name (Legal Business Name): RACHEL LARUE EDMEYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CENTERBROOKE LN STE 100
SUFFOLK VA
23434-8663
US

IV. Provider business mailing address

2000 PLYMOUTH RD STE 250
MINNETONKA MN
55305-2376
US

V. Phone/Fax

Practice location:
  • Phone: 757-702-8105
  • Fax:
Mailing address:
  • Phone: 952-767-2326
  • Fax: 952-593-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008350
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10078
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: