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General NPI Number Information
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NPI Number | 1124085303
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Entity Type | Individual
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Provider Name | HEIDI R KIMMEL PAC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2006
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 6363 FRANCE AVE S STE 525
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City | EDINA
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State | MN
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Zip | 55435-2129
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Country | US
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Telephone | 952-926-6489
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Fax | 952-926-6501
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Provider Business Mailing Address
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Address Line | 733 CHICAGO DR
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City | BURNSVILLE
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State | MN
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Zip | 55306-6448
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Country | US
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Telephone | 952-892-0434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9579
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License Number State | MN
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