MICHELLE RENEE WARK (NPI# 1952330581) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952330581 |
| Entity Type | Individual |
| Full Name | MICHELLE RENEE WARK |
| Credential | PAC |
| Practice Address |
5109 36th Ave N Crystal MN 55422 |
| Mailing Address |
5109 36th Ave N Crystal MN 55422-2007 |
| Practice Telephone | 7635877900 |
| Practice Fax Number | 7635877989 |
| Mailing Telephone | 7635877900 |
| Mailing Fax Number | 7635877989 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-10-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 9445 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 959621600 | 05 |
| Street Address |
5109 36TH AVE N |
| City | CRYSTAL |
| State | MN |
| Zip Code | 55422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336123611 | Paul Andy Ruth | Family Medicine | 5109 36th Ave N, Crystal, MN 55422-2007 | 2005-12-01 |
| 1114486453 | Taylor Dawson | Physician Assistant | 5109 36th Ave N, Crystal, MN 55422-2007 | 2019-03-17 |
| 1639643455 | North Clinic, Pa | Internal Medicine | 5109 36th Ave N, Crystal, MN 55422-2007 | 2019-01-15 |
| 1376054593 | Lisa Atkinson | Physician Assistant | 5109 36th Ave N, Crystal, MN 55422-2007 | 2017-10-15 |
| 1528327160 | Shelby Rae Spandl | Family Medicine | 5109 36th Ave N, Crystal, MN 55422-2007 | 2012-05-15 |
| 1487844734 | Mary E Broughton | Physician Assistant | 5109 36th Ave N, Crystal, MN 55422 | 2007-08-01 |
| 1437189057 | David C Smiley | Internal Medicine | 5109 36th Ave N, Crystal, MN 55422-2007 | 2006-07-03 |
| 1366470825 | Darrell A Krieger | Internal Medicine | 5109 36th Ave N, Crystal, MN 55422 | 2006-06-30 |
| 1659307205 | Kurt Steven Partoll | Internal Medicine | 5109 36th Ave N, Crystal, MN 55422-2007 | 2006-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154966794 | Trevor Velin | Chiropractor | Robin Center Chiropractic, Pa, 4080 W Broadway Ave, 310, Robbinsdale, MN 55422 | 2019-11-07 |
| 1780165134 | American Current Care of Minnesota PC | Clinic/Center | 4080 W Broadway Ave Ste 200, Robbinsdale, MN 55422 | 2018-08-23 |
| 1366928426 | Creekside Family Dental Pllc | Dentist | Giebenhain Dental Associates, P.a., 5851 Duluth Street # 103, Golden Valley, MN 55422 | 2018-07-12 |
| 1497249536 | Luke Utecht | Psychologist | 4150 Olson Memorial Hwy, Suite 420, Golden Valley, MN 55422 | 2018-06-21 |
| 1821582115 | Ajaa Oliver | Registered Nurse | 3606 Zenith Ave N, Robbinsdale, MN 55422 | 2018-06-19 |
| 1306348024 | Leila Jean Erlandson | Marriage & Family Therapist | Golden Valley Executive Center, 4284 Dahlberg Drive, Golden Valley, MN 55422 | 2018-03-08 |
| 1467969907 | Minneapolis Health Clinic Pllc | Internal Medicine | 4825 Olson Memorial Hwy., Suite 101, Golden Valley, MN 55422 | 2018-01-05 |
| 1275049116 | Lake Town Homecare, LLC | In Home Supportive Care | 4119 Scott Ave N, Robbinsdale, MN 55422 | 2017-12-14 |
| 1750894002 | Unihealth Home Care, LLC | Home Health | 1710 Douglas Dr N Ste 226j, Golden Valley, MN 55422 | 2017-11-08 |
| 1194172296 | Crosscultural Health Care Inc | Home Health | 5801 Duluth Street Suite 310, Golden Valley, MN 55422 | 2016-05-18 |
| Find all providers in zip 55422 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457335044 | Cynthia S Jansen | Physician Assistant | 4725 36th Ave N, Crystal, MN 55422-2169 | 2005-12-06 |
| 1114486453 | Taylor Dawson | Physician Assistant | 5109 36th Ave N, Crystal, MN 55422-2007 | 2019-03-17 |
| 1922514181 | Jessica Leigh Puchalski | Physician Assistant | 5700 Bottineau Blvd Ste 100, Crystal, MN 55429-3184 | 2017-12-22 |
| 1376054593 | Lisa Atkinson | Physician Assistant | 5109 36th Ave N, Crystal, MN 55422-2007 | 2017-10-15 |
| 1205107422 | Adam Robert Hetz | Physician Assistant | 4725 36th Ave N, Crystal, MN 55422-2169 | 2012-01-19 |
| 1992038236 | Heather Smith | Physician Assistant | 4725 36th Ave N, Crystal, MN 55422-2169 | 2009-09-17 |
| 1629122767 | Tammy Gregerson | Physician Assistant | 5502 W Broadway Ave, Crystal, MN 55428-3508 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265284 | Foua Vang | Physician Assistant | 689 County Road D E Apt 302, Saint Paul, MN 55117-1263 | 2020-11-08 |
| 1043811870 | Leiah Hoffman | Physician Assistant | 4243 Timberridge Ln Apt A, Hermantown, MN 55811-4047 | 2020-11-06 |
| 1760083059 | Amanda Hanover | Physician Assistant | 10346 Mississippi Blvd Nw, Coon Rapids, MN 55433-4521 | 2020-11-04 |
| 1780284844 | Lily Ganz | Physician Assistant | 2737 Huntington Ave, St Louis Park, MN 55416-3917 | 2020-10-28 |
| 1972103000 | Jaclyn Ann Bautch | Physician Assistant | 24721 State Highway 15, Saint Augusta, MN 56301-9211 | 2020-10-28 |
| 1801496047 | Tanner Vaughn Kramp | Physician Assistant | 3450 Wild Turkey Rd, Red Wing, MN 55066-1762 | 2020-10-27 |
| 1497354955 | Sarah Marti | Physician Assistant | 810 Thornton St Se Apt 904, Minneapolis, MN 55414-3652 | 2020-10-25 |
| 1598364473 | Kylee N Persing | Physician Assistant | 10 4th Ave S, Saint Cloud, MN 56301-3614 | 2020-10-21 |
| 1073112009 | Reece Edward Mcevoy | Physician Assistant | 2638 Sand Trap Rd Se, Rochester, MN 55904-3904 | 2020-10-21 |
| 1679189021 | Anne Elizabeth Drabot | Physician Assistant | 4741 Vincent Ave S, Minneapolis, MN 55410-1843 | 2020-09-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.