MEDICARE: MRS. AMY GROVENDER MARCHEWKA P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	11190	MN

General Provider Information

NPI Number	:	1023360765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY GROVENDER MARCHEWKA P.A.

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	122-629-0006
Fax Number	:	507-723-6447

Provider Business Practice Location Address
First Line	:	1155 COUNTY ROAD E E STE 100
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5191
Country	:	US
Telephone Number	:	651-241-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	06/09/2023

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