Individual
AMANDA J HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
8600 NICOLLET AVE S, MAIL STOP 31500A, BLOOMINGTON, MN 55420-2824
(952) 887-6600
(952) 886-7015
Mailing address
8170 33RD AVE S # 21110Q, BLOOMINGTON, MN 55425-4516
(952) 541-2800
(952) 886-7015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9933
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500684800
—
MN
Enumeration date
02/21/2006
Last updated
02/17/2020
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