Provider Demographics
NPI:1053468074
Name:EDMEYER, RACHEL LARUE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LARUE
Last Name:EDMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PLYMOUTH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2376
Mailing Address - Country:US
Mailing Address - Phone:952-767-2326
Mailing Address - Fax:952-593-5187
Practice Address - Street 1:1001 CENTERBROOKE LN STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8663
Practice Address - Country:US
Practice Address - Phone:757-702-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008350363A00000X
MN10078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical