Provider Demographics
NPI:1558336198
Name:BRANDT, REBECCA (PA C)
Entity Type:Individual
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First Name:REBECCA
Middle Name:
Last Name:BRANDT
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Gender:F
Credentials:PA C
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:763-587-4600
Mailing Address - Fax:763-587-4615
Practice Address - Street 1:15245 BLUEBIRD ST NW
Practice Address - Street 2:MAIL STOP 39300A
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3538
Practice Address - Country:US
Practice Address - Phone:763-587-4600
Practice Address - Fax:763-587-4615
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-04-18
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Provider Licenses
StateLicense IDTaxonomies
MN9523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN752533800Medicaid
MN752533800Medicaid
Q46389Medicare UPIN