Individual
CARLYN DEKONING RUDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4100 HAMLINE AVE N, SAINT PAUL, MN 55112-5700
(866) 389-2727
Mailing address
8251 COLUMBINE RD, EDEN PRAIRIE, MN 55344-7610
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10371
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T760272391313
DRIVER'S LICENSE
MN
Enumeration date
10/31/2007
Last updated
03/14/2020
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