Elizabeth Ann Vogstrom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9567 Issued in MN

Practice address

8981 Aztec Dr
Medispa
Eden Prairie, MN 55347

Phone

(612) 308-4300

NPI assigned

Oct 11, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Elizabeth Ann Vogstrom Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1356891519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8981 AZTEC DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553471916",
            "telephone_number": "612-308-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8981 AZTEC DR",
            "address_2": "MEDISPA",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "55347",
            "telephone_number": "612-308-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOGSTROM",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-11",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "VOGSTROM",
            "middle_name": "ANN",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physician Assistant in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.