Healthcare Provider Details

I. General information

NPI: 1104624006
Provider Name (Legal Business Name): JESSICA ACUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 KENWOOD AVE
DULUTH MN
55811-4199
US

IV. Provider business mailing address

1200 KENWOOD AVE
DULUTH MN
55811-4199
US

V. Phone/Fax

Practice location:
  • Phone: 763-292-1221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13339
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: