Individual
KELLY L DZIEDZIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 W 140TH ST UNIT 201, BURNSVILLE, MN 55337-4833
(952) 808-3000
(952) 808-3001
Mailing address
710 COMMERCE DR STE 200, WOODBURY, MN 55125-4925
(651) 968-5042
(651) 968-5904
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9792
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205559700
—
MN
Enumeration date
02/21/2006
Last updated
01/02/2019
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