MEDICARE: BROOKLYN GRACE GUNNARE 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	15826	MN

General Provider Information

NPI Number	:	1770448219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN GRACE GUNNARE PA-C

Provider Business Mailing Address
First Line	:	1955 OMEGA DR
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-5401
Country	:	US
Telephone Number	:	612-759-5624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 OMEGA DR
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-5401
Country	:	US
Telephone Number	:	612-759-5624
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	06/24/2026

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