Provider Demographics
NPI:1427143650
Name:VOGEL, ANNA CHRISTINE (PAC)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:CHRISTINE
Last Name:VOGEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CHRISTINE
Other - Last Name:VARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12115 63RD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-4627
Mailing Address - Country:US
Mailing Address - Phone:763-497-4351
Mailing Address - Fax:
Practice Address - Street 1:12115 63RD ST NE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4627
Practice Address - Country:US
Practice Address - Phone:763-497-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN682604100Medicaid
970002508Medicare ID - Type Unspecified
MN682604100Medicaid