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NPI Code Detail

MEDICARE: AMANDA MARIE PINKERT LOECKEN MHS, PA-C

MEDICARE: AMANDA MARIE PINKERT LOECKEN MHS, 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 Assistant
2363A00000XPhysician Assistant10201MN

General Provider Information

NPI Number : 1487761573
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MARIE PINKERT LOECKEN MHS, PA-C
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 4040 COON RAPIDS BLVD NW STE 120
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-4568
Country : US
Telephone Number : 763-427-9980
Fax Number : 763-427-0904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 04/12/2024

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