Provider Demographics
NPI:1528483799
Name:ROMANOWICZ, BRITA EMANUELL (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRITA
Middle Name:EMANUELL
Last Name:ROMANOWICZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITA
Other - Middle Name:EMANUELL
Other - Last Name:DAHLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 EARLE BROWN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2506
Practice Address - Country:US
Practice Address - Phone:952-993-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant