Provider Demographics
NPI:1578559928
Name:LINDEMAN, RUTH ELLEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELLEN
Last Name:LINDEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ELLEN
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1040 CRYSTAL LAKE RD W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6167
Mailing Address - Country:US
Mailing Address - Phone:612-720-6170
Mailing Address - Fax:
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:651-254-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970002500Medicare PIN