Healthcare Provider Details

I. General information

NPI: 1275521700
Provider Name (Legal Business Name): JENNIFER DEMING RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 TRETTEL LN
CLOQUET MN
55720-1345
US

IV. Provider business mailing address

602 SELFRIDGE DR
DULUTH MN
55811-5935
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-1227
  • Fax: 218-878-2136
Mailing address:
  • Phone: 218-722-6928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR137433-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: