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Individual

RUTH H MCGOWAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2945 HAZELWOOD ST STE 100, MAPLEWOOD, MN 55109-1242
(651) 232-7800
(651) 232-7940
Mailing address
2945 HAZELWOOD ST STE 100, MAPLEWOOD, MN 55109-1242
(651) 232-7800
(651) 232-7940

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
001738
IA
363AM0700X
Medical Physician Assistant
Primary
12697
MN
363AM0700X
Medical Physician Assistant
PA22945
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1205924156
IA
01
P00466587
RR MEDICARE
IA
Enumeration date
10/10/2006
Last updated
08/29/2018
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