Provider Demographics
NPI:1255769071
Name:ROHRER, AMANDA C (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:ROHRER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:ROUBIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:STE 110N
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:910 E 26TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4552
Practice Address - Country:US
Practice Address - Phone:612-884-6300
Practice Address - Fax:612-884-6363
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1996363AM0700X
MN11469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical