Provider Demographics
NPI:1346676319
Name:CECCONI, CATHERINE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:CECCONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHERIN
Other - Middle Name:ANNE
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2411 MAPLEWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1913
Mailing Address - Country:US
Mailing Address - Phone:651-797-6880
Mailing Address - Fax:651-797-6881
Practice Address - Street 1:2411 MAPLEWOOD DR N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1913
Practice Address - Country:US
Practice Address - Phone:651-797-6880
Practice Address - Fax:651-797-6881
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11444363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant