Provider Demographics
NPI:1073501243
Name:BATY, GABRIELLE MAUREEN (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MAUREEN
Last Name:BATY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MAUREEN
Other - Last Name:WINCZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1712
Mailing Address - Country:US
Mailing Address - Phone:651-999-6909
Mailing Address - Fax:651-999-6840
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6910
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN158402200Medicaid
MN970001984Medicare ID - Type Unspecified
MN158402200Medicaid