Individual
MARTHA MACDOUGAL MAGNUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3580 ARCADE ST, VADNAIS HEIGHTS, MN 55127
(651) 968-5770
(651) 968-5775
Mailing address
913 E 26TH ST STE 600, MINNEAPOLIS, MN 55404-4515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10433
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010453642
GREATWEST
ME
01
—
1316046931
TRICARE
ME
05
—
432035899
—
ME
Enumeration date
09/21/2006
Last updated
11/10/2020
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