Provider Demographics
NPI:1982036463
Name:PUIG-WONG, ELENA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:M
Last Name:PUIG-WONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:PUIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:909 FULTON ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-4800
Mailing Address - Country:US
Mailing Address - Phone:941-400-3295
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST STE 150
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2109
Practice Address - Country:US
Practice Address - Phone:952-920-7200
Practice Address - Fax:763-302-4234
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030946363AS0400X
MN12752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical