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NPI Code Detail

MEDICARE: STEPHANIE JEAN PIDDE PA-C

MEDICARE: STEPHANIE JEAN PIDDE 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 Assistant15509MN

General Provider Information

NPI Number : 1417703521
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE JEAN PIDDE PA-C
Provider Business Mailing Address
First Line : 2025 SLOAN PL STE 35
Second Line :
City : SAINT PAUL
State : MN
Zip : 55117-2092
Country : US
Telephone Number : 651-772-1572
Fax Number : 651-772-1889
Provider Business Practice Location Address
First Line : 280 SNELLING AVE N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-5330
Country : US
Telephone Number : 651-788-4444
Fax Number : 651-699-9257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2024
Last Update Date : 10/22/2025

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Directions to “ STEPHANIE JEAN PIDDE PA-C” Practice Location

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