Provider Demographics
NPI:1316352578
Name:CHUBA, KRISTEN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:CHUBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:ROLLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1856 BEAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1162
Mailing Address - Country:US
Mailing Address - Phone:651-661-6550
Mailing Address - Fax:
Practice Address - Street 1:1856 BEAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1162
Practice Address - Country:US
Practice Address - Phone:651-661-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant