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General NPI Number Information
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NPI Number | 1477036317
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Entity Type | Individual
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Provider Name | GINA KLEVE DARDINE PA
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 237 RADIO DRIVE SUITE 210
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 612-502-5092
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Fax | 612-870-5491
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Provider Business Mailing Address
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Address Line | 3001 BROADWAY ST. NE SUITE 500
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City | MINNEAPOLIS
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State | MN
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Zip | 55413
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Country | US
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Telephone | 612-871-1145
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Fax | 612-870-5491
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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 | 12782
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License Number State | MN
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