Provider Demographics
NPI:1619374030
Name:STUTRUD, JOY ANN (PA)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ANN
Last Name:STUTRUD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:ANN
Other - Last Name:SAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5565 BLAINE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1238
Mailing Address - Country:US
Mailing Address - Phone:651-621-8888
Mailing Address - Fax:651-621-8805
Practice Address - Street 1:5565 BLAINE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1238
Practice Address - Country:US
Practice Address - Phone:651-621-8888
Practice Address - Fax:651-621-8805
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant