Healthcare Provider Details

I. General information

NPI: 1952612525
Provider Name (Legal Business Name): JENNIFER MARY SCHLIES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 FAIRVIEW DR STE 420
BURNSVILLE MN
55337-2539
US

IV. Provider business mailing address

1700 HIGHWAY 25 NORTH BUFFALO CLINIC
BUFFALO MN
55313
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3282
  • Fax:
Mailing address:
  • Phone: 763-682-1313
  • Fax: 763-271-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57891
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: