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NPI Code Detail

MEDICARE: ERIN MARIE GOTTESLEBEN PA-C

MEDICARE: ERIN MARIE GOTTESLEBEN 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
1363A00000XPhysician Assistant12966MN

General Provider Information

NPI Number : 1346706645
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN MARIE GOTTESLEBEN PA-C
Provider Business Mailing Address
First Line : 6363 FRANCE AVE S STE 400
Second Line :
City : EDINA
State : MN
Zip : 55435-2130
Country : US
Telephone Number : 952-920-2070
Fax Number : 952-920-7444
Provider Business Practice Location Address
First Line : 6363 FRANCE AVE S STE 400
Second Line :
City : EDINA
State : MN
Zip : 55435-2142
Country : US
Telephone Number : 952-920-2070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2019
Last Update Date : 12/27/2019

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