Provider Demographics
NPI:1457090060
Name:BECKMAN, CARRISSA (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:CARRISSA
Middle Name:
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:CARRISSA
Other - Middle Name:
Other - Last Name:ROLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8559 EDINBROOK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3728
Mailing Address - Country:US
Mailing Address - Phone:763-581-5660
Mailing Address - Fax:
Practice Address - Street 1:8559 EDINBROOK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55443-3728
Practice Address - Country:US
Practice Address - Phone:763-581-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1193175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant