Individual
MARJORIE L VAN DER HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7373 FRANCE AVE S, SUITE 312, EDINA, MN 55435-4534
(952) 832-0076
(952) 832-9881
Mailing address
6465 WAYZATA BLVD, SUITE 900, ST LOUIS PARK, MN 55426-1728
(952) 512-5600
(952) 512-5650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9413
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114933
MEDICA
—
01
—
12339E948
UCARE
—
01
—
73B61VA
BLUE CROSS BLUE SHIELD
—
01
—
969991018909
PREFERREDONE
—
01
—
HP45664
HEALTHPARTNERS
—
Enumeration date
08/11/2006
Last updated
07/11/2007
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