MEDICARE: JENNIFER C CLEARY 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
1	363A00000X	Physician Assistant	13713	MN

General Provider Information

NPI Number	:	1972174886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C CLEARY PA-C

Provider Business Mailing Address
First Line	:	4917 EDEN AVE APT 225
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55424-2201
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5491

Provider Business Practice Location Address
First Line	:	5705 W OLD SHAKOPEE RD STE 150
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-3126
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	612-870-5491

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

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	09/16/2025

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