1053510842 NPI number — GINA RUTH FIGI PASEKA P.A.

Table of content: GINA RUTH FIGI PASEKA P.A. (NPI 1053510842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053510842 NPI number — GINA RUTH FIGI PASEKA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASEKA
Provider First Name:
GINA
Provider Middle Name:
RUTH FIGI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PASEKA
Provider Other First Name:
GINA
Provider Other Middle Name:
R. FIGI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053510842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1450, NW 6035
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55485-6035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-738-4456
Provider Business Mailing Address Fax Number:
952-738-4438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5775 WAYZATA BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ST. LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416-2698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-738-4488
Provider Business Practice Location Address Fax Number:
952-543-6524
Provider Enumeration Date:
07/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  10294 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10294 . This is a "PHYSICIAN ASSISTANT LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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