Individual
REBECCA CANTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 OSBORNE RD NE, FRIDLEY, MN 55432-2765
(763) 236-2180
(763) 236-2067
Mailing address
500 OSBORNE RD NE, FRIDLEY, MN 55432-2765
(763) 236-2180
(763) 236-2067
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1369
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369
STATE MEDICAL LICENSE
MN
01
—
50.001798
STATE OF OHIO MEDICAL BOA
OH
Enumeration date
12/20/2006
Last updated
01/26/2010
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