Provider Demographics
NPI:1609842632
Name:EVENSON, TROY MICHAEL (PA C)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:MICHAEL
Last Name:EVENSON
Suffix:
Gender:M
Credentials:PA C
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Mailing Address - Street 1:4200 DAHLBERG DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4841
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:
Practice Address - Street 1:5601 96TH AVE N STE 200
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4505
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-11-03
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Provider Licenses
StateLicense IDTaxonomies
MN9710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN408377600Medicaid
MN970003874Medicare PIN
MNP55452Medicare UPIN