IndividualActive
Jeremy Lane, P.A.-C.
NPI 1144205220 · Surgical Physician Assistant · St Louis Park, MN
Provider details
- NPI number
- 1144205220
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- P.A.-C.
- Sex
- Male
- Sole proprietor
- No
- License
- 9937 (MN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone: (952) 993-3230
Fax: (952) 993-1748
Approximate (ZIP-level) locationGet directions
Mailing address
3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Registry dates
- Enumerated
- 2005-12-12
- Last updated
- 2019-03-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.