Healthcare Provider Details

I. General information

NPI: 1457904732
Provider Name (Legal Business Name): JAZMINE MARIE NESVIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 18TH AVE E
ALEXANDRIA MN
56308-2511
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308-3426
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-6107
  • Fax: 320-759-4327
Mailing address:
  • Phone: 320-763-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2019022955
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: