Provider Demographics
NPI:1134842115
Name:BRETHAUER, HANNAH (PA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BRETHAUER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:GALLMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD STE 135
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6770
Practice Address - Country:US
Practice Address - Phone:651-312-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14225363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant