Provider Demographics
NPI:1255353348
Name:MAENKE, GAIL MARIE (OPA-C)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:MAENKE
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5650
Practice Address - Street 1:1000 W 140TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:952-808-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP57380OtherHEALTHPARTNERS