Provider Demographics
NPI:1780838102
Name:ROVERUD, REBEKAH ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:ANN
Last Name:ROVERUD
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Gender:F
Credentials:PA
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Mailing Address - Street 1:14001 RIDGEDALE DR
Mailing Address - Street 2:#200
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1753
Mailing Address - Country:US
Mailing Address - Phone:952-249-2000
Mailing Address - Fax:952-249-2099
Practice Address - Street 1:14001 RIDGEDALE DR
Practice Address - Street 2:#200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1753
Practice Address - Country:US
Practice Address - Phone:952-249-2000
Practice Address - Fax:952-249-2099
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2009-01-22
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Provider Licenses
StateLicense IDTaxonomies
MN10502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant