Provider Demographics
NPI:1710251434
Name:KANSARA, LINA NGA (PA-C)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:NGA
Last Name:KANSARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NGA
Other - Middle Name:PHA
Other - Last Name:DAO (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:5201 HALIFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1402
Mailing Address - Country:US
Mailing Address - Phone:612-875-9961
Mailing Address - Fax:
Practice Address - Street 1:2807 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1844
Practice Address - Country:US
Practice Address - Phone:763-237-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MN11090363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical