CLARK ETTEN (NPI# 1265940795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265940795 |
| Entity Type | Individual |
| Full Name | CLARK ETTEN |
| Credential | PA-C |
| Practice Address |
4300 Marketpointe Dr Ste 100 Bloomington MN 55435-5435 |
| Practice Telephone | 9528359880 |
| Practice Fax Number | 9528571554 |
| Mailing Telephone | 9528359880 |
| Mailing Fax Number | 9528571554 |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4300 MARKETPOINTE DR STE 100 |
| City | BLOOMINGTON |
| State | MN |
| Zip Code | 55435-5435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487634226 | Luis A Martinez | Emergency Medicine | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435 | 2006-01-18 |
| 1710517669 | Brittney Marie Joachim | Nurse Practitioner | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2020-01-20 |
| 1306476460 | Monica Le | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2020-01-16 |
| 1063062552 | Nicole E Lipinski | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2019-09-17 |
| 1205486636 | Joseph James Eisenschenk | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2019-09-17 |
| 1275183063 | Brita Koivisto | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2019-09-13 |
| 1972153765 | Emily Bayles | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2019-09-13 |
| 1518528751 | Rachel Marie Kierski | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2019-06-27 |
| 1295207454 | Ryan Davies Steele | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2018-12-27 |
| 1013488865 | Haley Johnson | Physician Assistant | 4300 Marketpointe Dr Ste 100, Bloomington, MN 55435-5435 | 2018-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104433416 | Evy Christine Claussen | Social Worker | 6363 France Ave. S., Edina, MN 55435 | 2020-09-30 |
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1730651639 | Taylor Lee Kehoe | Physician Assistant | 7400 France Ave., Suite #100, Edina, MN 55435 | 2018-12-18 |
| 1538666326 | Amanda Deangelo | Physical Therapist | 6401 Southdale Hospital, Ll3g, Edina, MN 55435 | 2018-04-09 |
| 1982107876 | Julia Seliber | Dental Hygienist | 7600 France Ave.s. Suite 1100, Edina, MN 55435 | 2018-03-16 |
| 1154840064 | Southhealth Asc, LLC | Clinic/Center | 4100 Minnesota Drive, Edina, MN 55435 | 2017-09-12 |
| 1730605528 | Edina Medical Supplies | Durable Medical Equipment & Medical Supplies | 7455 France Ave., #614 S, Edina, MN 55435 | 2017-08-14 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1306206321 | Barb Ryan | Mechanotherapist | 7550 France Avenue S, #220, Edina, MN 55435 | 2016-03-03 |
| Find all providers in zip 55435 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508496621 | Samantha Jean Mcgough Lamere | Physician Assistant | 4300 Marketpointe Drive, Suite 100, Bloomington, MN 55435 | 2020-01-16 |
| 1386292886 | Quinn Harmon | Physician Assistant | 1310 W Bloomfield Rd Ste C, Bloomington, IN 47403-2001 | 2019-08-28 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1730619487 | Elise Nicole Lill | Physician Assistant | 4300 Market Pte Dr Ste 100, Bloomington, MN 55435-5435 | 2017-06-15 |
| 1528417557 | Kathryn Shalbrack | Physician Assistant | 4300 Marketpointe Dr, Bloomington, MN 55435-5423 | 2016-06-09 |
| 1740634203 | Alfonso Luna IIi | Physician Assistant | 657 S Lancewood Ave, Bloomington, CA 92316-1336 | 2016-04-20 |
| 1215308671 | Sara Ann Houk | Physician Assistant | 2200 E. Washington St, Bloomington, IL 61701-4323 | 2015-10-12 |
| 1760865133 | Patrick D Machacek | Physician Assistant | 10633 Vincent Ave S, Bloomington, MN 55431-3733 | 2015-07-03 |
| 1558740803 | Samuel Johnson | Physician Assistant | 2901 Metro Drive, Suite 527, Bloomington, MN 55122 | 2015-05-20 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 55435 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.