Organization
FAIRVIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAITLIN JANE GOULET (PHYSICIAN ASSISTANT)
(651) 270-6699
Entity
Organization
Contact information
Practice address
2450 RIVERSIDE AVE STE MN213, MINNEAPOLIS, MN 55454-1450
(612) 273-3000
Mailing address
2450 RIVERSIDE AVE STE MN213, MINNEAPOLIS, MN 55454-1450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/05/2025
Last updated
12/05/2025
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