Facts
- Status
- A
- Credential
- APRN
- Type
- Individual
- Enumeration date
- 2017-11-22
- Last updated
- 2017-11-22
Specialties
Licenses
- License MN
- 5520
Location
- Practice location
- 1430 NORTH HWY
- City
- JACKSON MN
- Postal code
- 561431093
- Phone
- 507-847-2420
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.