Provider Demographics
NPI:1356888275
Name:BORASH, AMY SPITZMUELLER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SPITZMUELLER
Last Name:BORASH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:IRENE
Other - Last Name:SPITZMUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4465 WHITE BEAR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-7623
Mailing Address - Country:US
Mailing Address - Phone:651-653-0062
Mailing Address - Fax:
Practice Address - Street 1:4465 WHITE BEAR PARKWAY
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-7623
Practice Address - Country:US
Practice Address - Phone:651-653-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363A00000X
MN12339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant