Individual
MRS. ANDREA JO PITZL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3208 36TH AVE NE, ST ANTHONY, MN 55418-1713
(612) 805-5015
Mailing address
3208 36TH AVE NE, ST ANTHONY, MN 55418-1713
(612) 805-5015
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
11081
MN
363AS0400X
Surgical Physician Assistant
1668
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01138670
RAILROAD MEDICARE
MN
Enumeration date
01/23/2012
Last updated
11/13/2015
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