Individual
VANESSA RUTH LOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4151 WILLOWWOOD ST SE, PRIOR LAKE, MN 55372-4304
(855) 324-7843
Mailing address
1700 UNIVERSITY AVE W, SAINT PAUL, MN 55104-3727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15019
MN
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/05/2022
Last updated
08/13/2024
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