Provider Demographics
NPI:1629623525
Name:ERTSGAARD, REBECCA LENORE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LENORE
Last Name:ERTSGAARD
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Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:3601 MINNESOTA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5281
Mailing Address - Country:US
Mailing Address - Phone:612-879-1000
Mailing Address - Fax:612-879-9116
Practice Address - Street 1:11091 ULYSSES ST NE STE 100
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4238
Practice Address - Country:US
Practice Address - Phone:612-879-1000
Practice Address - Fax:612-879-0722
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-07-30
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Provider Licenses
StateLicense IDTaxonomies
MN103522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology