MEDICARE: JACQUELINE SII

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
1	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program		MN

General Provider Information

NPI Number	:	1942132501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SII

Provider Business Mailing Address
First Line	:	1125 LAGOON AVE UNIT 528
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-5156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 LAGOON AVE UNIT 528
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-5156
Country	:	US
Telephone Number	:	715-697-4060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “ JACQUELINE SII ” Practice Location

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