Provider Demographics
NPI:1477036317
Name:DARDINE, GINA KLEVE (PA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:KLEVE
Last Name:DARDINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:KLEVE
Other - Last Name:BERNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3001 BROADWAY ST. NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413
Mailing Address - Country:US
Mailing Address - Phone:612-871-1145
Mailing Address - Fax:612-870-5491
Practice Address - Street 1:237 RADIO DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:612-502-5092
Practice Address - Fax:612-870-5491
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant