Individual provider · Type 1 NPI

Mallory Quinn De Boom, PA

Physician Assistant · St. Paul, MN

NPI number 1801540646 Active

Practice location

225 Smith Ave N Ste 400
St. Paul, MN 55102-2568

Call (651) 290-0133 Map

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant 363AM0700XNone listed
Physician Assistant 363A00000X4931 (TN)
Physician Assistant Primary 363A00000X15407 (MN)

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, orde…

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About NPI 1801540646

Mallory Quinn De Boom, PA's National Provider Identifier is 1801540646, issued on Feb 10, 2022. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in St. Paul, MN. The record was last updated on Sep 2, 2026.