Madelyn Rae Petry, PA is a
Student In An Organized Health Care Education/training Program based in Shoreview, Minnesota. Madelyn Rae Petry is licensed to practice in * (Not Available) (license number ) and her current practice location is
4257 Highland Dr, Shoreview, Minnesota. She can be reached at her office (for appointments etc.) via phone at
(651) 252-9011.
NPI number for Madelyn Rae Petry is 1205557428 and her current mailing address is 4257 Highland Dr, Shoreview, Minnesota. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1205557428.
Provider's Profile
| Full Name | Madelyn Rae Petry |
|---|
| Gender | Female |
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| Speciality | Student In An Organized Health Care Education/training Program |
|---|
| Location | 4257 Highland Dr, Shoreview, Minnesota |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1205557428
- Provider Enumeration Date: 09/06/2022
- Last Update Date: 09/06/2022
Medical Identifiers
Medical identifiers for Madelyn Rae Petry such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1205557428 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Madelyn Rae Petry is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Madelyn Rae Petry, PA
4257 Highland Dr,
Shoreview, MN 55126-3124
Ph: (651) 252-9011 | Madelyn Rae Petry, PA
4257 Highland Dr,
Shoreview, MN 55126-3124
Ph: (651) 252-9011 |
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