Provider Demographics
NPI:1881017150
Name:THILGES, DANA (PA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:THILGES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:SHOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:13819 HANSON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7608
Mailing Address - Country:US
Mailing Address - Phone:763-862-2091
Mailing Address - Fax:
Practice Address - Street 1:13819 HANSON BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7608
Practice Address - Country:US
Practice Address - Phone:763-862-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09019363A00000X
MN2550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340731401Medicaid
TXC0204277OtherCSR
MS3154072OtherDEA NUMBER
TX375272YV3QMedicare Oscar/Certification