Individual
SOFIA NIKOLAYEVNA VASILYEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1000 W. 140TH ST., SUITE #100, BURNSVILLE, MN 55337
(952) 435-0303
(952) 892-5166
Mailing address
1000 W. 140TH ST., SUITE #100, BURNSVILLE, MN 55337
(952) 435-0303
(952) 892-5166
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14242
MN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14242
MN PA LICENSE
MN
Enumeration date
04/07/2022
Last updated
01/18/2024
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