Provider Demographics
NPI:1619942281
Name:OPAL, PATRICIA A (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:OPAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 WESTGATE DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1065
Mailing Address - Country:US
Mailing Address - Phone:612-262-7800
Mailing Address - Fax:612-262-7022
Practice Address - Street 1:8101 34TH AVENUE SOUTH
Practice Address - Street 2:MS 26602G
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55425-4516
Practice Address - Country:US
Practice Address - Phone:952-883-6805
Practice Address - Fax:952-883-6117
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1372740363L00000X
MN0847363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN307148100Medicaid
MN307148100Medicaid
MN307148100Medicaid