Provider Demographics
NPI:1386288793
Name:JORGENSON-RATHKE, DENNIS TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:TAYLOR
Last Name:JORGENSON-RATHKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3601 MINNESOTA DRIVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:612-879-1000
Mailing Address - Fax:612-879-9116
Practice Address - Street 1:11091 ULYSSES ST NE STE 100
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4238
Practice Address - Country:US
Practice Address - Phone:612-879-1000
Practice Address - Fax:612-879-0722
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2024-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN13207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant