Provider Demographics
NPI:1659387637
Name:KAUFMAN, DANA LYNN (PAC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
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 1:4040 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-3237
Practice Address - Country:US
Practice Address - Phone:651-439-8807
Practice Address - Fax:651-439-0232
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2040363A00000X, 363AS0400X
MN10129363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70817Medicare UPIN
Q70817Medicare UPIN
MN0572890001Medicare NSC
MN587603000Medicaid
WI56080-0032Medicare PIN
MN970002666Medicare PIN
WI42890600Medicaid