Provider Demographics
NPI:1922510346
Name:BAUMANN, AMBER ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ALEXANDRA
Last Name:BAUMANN
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 1:12450 WAYZATA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1927
Mailing Address - Country:US
Mailing Address - Phone:952-546-6866
Mailing Address - Fax:952-512-0038
Practice Address - Street 1:12450 WAYZATA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1927
Practice Address - Country:US
Practice Address - Phone:952-546-6866
Practice Address - Fax:952-512-0038
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant