Provider Demographics
NPI:1588954887
Name:TEAGUE, REBEKAH ANN (PA)
Entity type:Individual
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First Name:REBEKAH
Middle Name:ANN
Last Name:TEAGUE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4769
Mailing Address - Country:US
Mailing Address - Phone:763-302-4114
Mailing Address - Fax:763-302-4081
Practice Address - Street 1:CLINIC AND SPECIALTY CENTER
Practice Address - Street 2:715 SOUTH 8TH STREET A3
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-873-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2018-10-18
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Provider Licenses
StateLicense IDTaxonomies
MN10954363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10954OtherMINNESOTA