Provider Demographics
NPI:1699166082
Name:FORSLINE, LINNEA MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LINNEA
Middle Name:MARIE
Last Name:FORSLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LINNEA
Other - Middle Name:MARIE
Other - Last Name:PINCKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-967-7175
Mailing Address - Fax:612-341-1432
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:952-967-7175
Practice Address - Fax:612-341-1432
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant