Provider Demographics
NPI:1124012638
Name:LOKEN, ELIZABETH FELL (PAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FELL
Last Name:LOKEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-351-8180
Mailing Address - Fax:651-351-8179
Practice Address - Street 1:5701 STILLWATER BLVD N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1030
Practice Address - Country:US
Practice Address - Phone:651-351-8180
Practice Address - Fax:651-351-8179
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9806363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33792Medicare UPIN
MN970001950Medicare PIN