Provider Demographics
NPI:1962977728
Name:YADETTA, DALESO (PA)
Entity type:Individual
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First Name:DALESO
Middle Name:
Last Name:YADETTA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5311
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2774
Practice Address - Country:US
Practice Address - Phone:763-712-2100
Practice Address - Fax:763-712-2190
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
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Provider Licenses
StateLicense IDTaxonomies
MN12817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant