Provider Demographics
NPI:1912964909
Name:WOJAHN, ANDREA RACHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RACHELLE
Last Name:WOJAHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RACHELLE
Other - Last Name:HUTCHENS-WOJAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15650 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7283
Mailing Address - Country:US
Mailing Address - Phone:952-997-4118
Mailing Address - Fax:
Practice Address - Street 1:15650 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7022
Practice Address - Country:US
Practice Address - Phone:952-997-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00088Medicare UPIN