Individual
KELLY VAN DYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2720 FAIRVIEW AVE N STE 100, ROSEVILLE, MN 55113-1306
(651) 241-5290
(651) 241-5248
Mailing address
2720 FAIRVIEW AVE N STE 100, ROSEVILLE, MN 55113-1306
(651) 241-5290
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2545
MN
Other
Enumeration date
08/16/2016
Last updated
01/13/2022
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