Provider Demographics
NPI:1033299854
Name:SCHELLER, AMY O (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:O
Last Name:SCHELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4379
Mailing Address - Country:US
Mailing Address - Phone:612-706-2900
Mailing Address - Fax:
Practice Address - Street 1:2600 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4379
Practice Address - Country:US
Practice Address - Phone:612-706-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN130130600Medicaid
MNS76553Medicare UPIN
MN970000474Medicare ID - Type Unspecified