Provider Demographics
NPI:1689447310
Name:GRYGIEL, CARRAS QUINN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRAS
Middle Name:QUINN
Last Name:GRYGIEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 EXCELSIOR BLVD STE 712
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2906
Mailing Address - Country:US
Mailing Address - Phone:763-465-0500
Mailing Address - Fax:
Practice Address - Street 1:2820 INGLEWOOD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4112
Practice Address - Country:US
Practice Address - Phone:763-465-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant