Basic Information
| Provider Information | |||||||||
| NPI: | 1235109356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAHLIN | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | SEJIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4570 W 77TH ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554355038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525677400 | ||||||||
| FaxNumber: | 9528522356 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 RAYMOND AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551141522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524847661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 9956 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 9956 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.