Healthcare Provider Details

I. General information

NPI: 1275305153
Provider Name (Legal Business Name): JACQUELINE RENAE HOWARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 BLUEBIRD ST NW
ANDOVER MN
55304-3538
US

IV. Provider business mailing address

15151 IGUANA ST NW
RAMSEY MN
55303-7134
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4688
  • Fax:
Mailing address:
  • Phone: 763-222-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2279363
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11105
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: