Provider Demographics
NPI:1891856050
Name:RAHBERG, ELIZABETH A (PA C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:RAHBERG
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5415 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3359
Mailing Address - Country:US
Mailing Address - Phone:763-533-8666
Mailing Address - Fax:763-533-8711
Practice Address - Street 1:5415 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3359
Practice Address - Country:US
Practice Address - Phone:763-533-8666
Practice Address - Fax:763-533-8711
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN582437100Medicaid
MN970000752Medicare ID - Type Unspecified
MN582437100Medicaid