Provider Demographics
NPI:1720602485
Name:BOURGET, RACHEL VALERIE (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:VALERIE
Last Name:BOURGET
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 1:6025 LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1710
Mailing Address - Country:US
Mailing Address - Phone:651-999-6800
Mailing Address - Fax:
Practice Address - Street 1:6025 LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1710
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty