Individual
MAY MUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
401 PHALEN BLVD, SAINT PAUL, MN 55130
(651) 254-7820
(651) 254-7827
Mailing address
8170 33RD AVENUE SOUTH, MS 21110Q, BLOOMINGTON, MN 55425-4516
(651) 254-7820
(651) 254-7827
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9664
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146309800
—
MN
Enumeration date
02/28/2006
Last updated
10/30/2018
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