Provider Demographics
NPI:1124329503
Name:ANDERSON, EMILY MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:914 S 8TH ST
Mailing Address - Street 2:S6
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1210
Mailing Address - Country:US
Mailing Address - Phone:612-347-5320
Mailing Address - Fax:612-373-1886
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:R1
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3131
Practice Address - Fax:612-904-4242
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
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Provider Licenses
StateLicense IDTaxonomies
MN1511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant