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General NPI Number Information
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NPI Number | 1275850927
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Entity Type | Individual
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Provider Name | ERIC RYAN VAN HECKE PA-C, MPAS
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Gender | Male
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 4600 LAKE ROAD AVE STE 301
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1845
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Country | US
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Telephone | 763-588-7099
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Fax | 763-522-2222
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Provider Business Mailing Address
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Address Line | 4600 LAKE ROAD AVE STE 301
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1845
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Country | US
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Telephone | 763-588-7099
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Fax | 763-522-2222
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10627
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License Number State | MN
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