Provider Demographics
NPI:1508205386
Name:CICCONI, CLARE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:ELIZABETH
Last Name:CICCONI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-3456
Mailing Address - Fax:651-254-9673
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:651-254-9673
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2020-01-16
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Provider Licenses
StateLicense IDTaxonomies
MN12881363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant