Individual
CARLEY JEAN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
701 DELLWOOD ST S, CAMBRIDGE, MN 55008-1920
(763) 689-8700
(763) 688-7941
Mailing address
PO BOX 43, MINNEAPOLIS, MN 55440-0043
(612) 262-1166
(612) 262-9035
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA12540
TX
Other
Enumeration date
12/04/2018
Last updated
01/04/2024
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