Healthcare Provider Details

I. General information

NPI: 1851127658
Provider Name (Legal Business Name): JAZMYN ARVIDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 30TH AVE E
ALEXANDRIA MN
56308-4769
US

IV. Provider business mailing address

14055 COUNTY HIGHWAY 42
PARKERS PRAIRIE MN
56361-2601
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2461347
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: