Individual
MRS. KIMBERLY DAWN BLEASDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8301 47TH AVE N, NEW HOPE, MN 55428-4512
(763) 504-4935
(763) 504-4932
Mailing address
8301 47TH AVE N, NEW HOPE, MN 55428-4512
(763) 504-4935
(763) 504-4932
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10493
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000864
—
WV
Enumeration date
06/02/2005
Last updated
05/18/2015
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