Individual
SIDA BAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7500 FRANCE AVE S, EDINA, MN 55435-3400
(952) 927-6501
(833) 905-0988
Mailing address
3001 METRO DR STE 460, BLOOMINGTON, MN 55425-1548
(651) 999-7022
(651) 999-6970
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14780
MN
Other
Enumeration date
11/13/2018
Last updated
09/17/2024
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