Healthcare Provider Details

I. General information

NPI: 1376959924
Provider Name (Legal Business Name): BARBARA JEZORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR STE 240
ARDEN HILLS MN
55112-6991
US

IV. Provider business mailing address

4360 MCDONALD DRIVE CT N
STILLWATER MN
55082-2126
US

V. Phone/Fax

Practice location:
  • Phone: 651-633-7300
  • Fax: 651-633-7301
Mailing address:
  • Phone: 651-270-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 124770-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: