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Individual

REBEKAH ANN TEAGUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
CLINIC AND SPECIALTY CENTER, 715 SOUTH 8TH STREET A3, MINNEAPOLIS, MN 55404
(612) 873-7151
Mailing address
9825 HOSPITAL DR, SUITE 103, MAPLE GROVE, MN 55369-4769
(763) 302-4114
(763) 302-4081

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10954
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10954
MINNESOTA
MN
Enumeration date
04/08/2011
Last updated
10/18/2018
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