Provider Demographics
NPI:1245444561
Name:RATAJCZAK, AMY JO (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:RATAJCZAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:207 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SABIN
Mailing Address - State:MN
Mailing Address - Zip Code:56580-4138
Mailing Address - Country:US
Mailing Address - Phone:218-789-7169
Mailing Address - Fax:
Practice Address - Street 1:1517 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5905
Practice Address - Country:US
Practice Address - Phone:701-232-6211
Practice Address - Fax:701-364-9346
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPAC0295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant