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NPI Code Detail

MEDICARE: JILL JASPERSON PA-C

MEDICARE: JILL JASPERSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant10794MN
2363A00000XPhysician Assistant10794MN

General Provider Information

NPI Number : 1083914428
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL JASPERSON PA-C
Provider Business Mailing Address
First Line : 4531 34TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-3834
Country : US
Telephone Number : 612-669-2174
Fax Number :
Provider Business Practice Location Address
First Line : 1040 GRAND AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3001
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2010
Last Update Date : 11/02/2022

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