MEDICARE: RACHEL LARUE EDMEYER PA-C

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	363A00000X	Physician Assistant	0110008350	VA
2	363AM0700X	Medical Physician Assistant	10078	MN

General Provider Information

NPI Number	:	1053468074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LARUE EDMEYER PA-C

Provider Business Mailing Address
First Line	:	2000 PLYMOUTH RD STE 250
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-2376
Country	:	US
Telephone Number	:	952-767-2326
Fax Number	:	952-593-5187

Provider Business Practice Location Address
First Line	:	1001 CENTERBROOKE LN STE 100
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8663
Country	:	US
Telephone Number	:	757-702-8105
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	09/15/2025

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