Provider Demographics
NPI:1144238957
Name:ROSSI, HEATHER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:ROSSI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1055 WESTGATE DR
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1065
Mailing Address - Country:US
Mailing Address - Phone:651-312-1500
Mailing Address - Fax:651-312-1593
Practice Address - Street 1:3738 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2629
Practice Address - Country:US
Practice Address - Phone:651-312-1717
Practice Address - Fax:651-312-1570
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-06-20
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Provider Licenses
StateLicense IDTaxonomies
MN46615208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN772622800Medicaid
MN772622800Medicaid
MN280000104Medicare ID - Type Unspecified