Healthcare Provider Details

I. General information

NPI: 1942647532
Provider Name (Legal Business Name): JACQUELYN RYAN MESSER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN RYAN COOK

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST
DULUTH MN
55805-1951
US

IV. Provider business mailing address

1000 E 1ST ST STE. N203
DULUTH MN
55805-2297
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-249-6960
  • Fax: 218-249-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number185004-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: