Provider Demographics
NPI:1356789952
Name:MOBERG, RACHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MOBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 53RD AVE NE
Mailing Address - Street 2:CVS MINUTE CLINIC
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1240
Mailing Address - Country:US
Mailing Address - Phone:763-571-9361
Mailing Address - Fax:
Practice Address - Street 1:755 53RD AVE NE
Practice Address - Street 2:CVS MINUTE CLINIC
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55421-1240
Practice Address - Country:US
Practice Address - Phone:763-571-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant