Provider Demographics
NPI:1326384223
Name:RODRIGUEZ, ALLISON MARY (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARY
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARY
Other - Last Name:RIVARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6565 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2141
Mailing Address - Country:US
Mailing Address - Phone:529-806-0011
Mailing Address - Fax:952-806-9741
Practice Address - Street 1:6565 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2141
Practice Address - Country:US
Practice Address - Phone:529-806-0011
Practice Address - Fax:952-806-9741
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X, 363AM0700X, 363AS0400X
MN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical