Individual
ALEX BLOOMQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
560 S MAPLE ST, WACONIA, MN 55387-1733
(952) 442-2191
Mailing address
500 S MAPLE ST, WACONIA, MN 55387-1752
(952) 442-2191
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15045
MN
Other
Enumeration date
08/18/2022
Last updated
11/16/2024
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