Provider Demographics
NPI:1245221860
Name:PELKOLA, REBECCA ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:PELKOLA
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 1:913 EAST 26TH STREET
Mailing Address - Street 2:TWIN CITIES SPINE CENTER PIPER BUILDING, SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4515
Mailing Address - Country:US
Mailing Address - Phone:612-775-6200
Mailing Address - Fax:612-775-6222
Practice Address - Street 1:913 EAST 26TH STREET
Practice Address - Street 2:TWIN CITIES SPINE CENTER PIPER BUILDING, SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4515
Practice Address - Country:US
Practice Address - Phone:612-775-6200
Practice Address - Fax:612-775-6222
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17779363A00000X
NVPA900363A00000X
MN11014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA177790Medicaid
NVCC7589OtherBCBS
NV100505782Medicaid
NVCC7589OtherBCBS
NV100505782Medicaid
CA0PA177790Medicare PIN