Provider Demographics
NPI:1386680346
Name:JUVONEN, KARLA RAE (PA)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:RAE
Last Name:JUVONEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:RAE
Other - Last Name:JOHANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS: 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-767-1900
Mailing Address - Fax:651-767-1901
Practice Address - Street 1:14701 VICTOR HUGO BLVD N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4561
Practice Address - Country:US
Practice Address - Phone:651-767-1900
Practice Address - Fax:651-767-1901
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP27780OtherHEALTHPARTNERS #
MN877918000Medicaid
MN143396OtherUCARE #
MN143396OtherUCARE #