Provider Demographics
NPI:1013458009
Name:ROSS, ABBY J (PA-C)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:J
Other - Last Name:MOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4919
Mailing Address - Country:US
Mailing Address - Phone:651-968-5201
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:2090 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2522
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:651-968-5904
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12369363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical