Healthcare Provider Details

I. General information

NPI: 1700948536
Provider Name (Legal Business Name): JANE E VANROEKEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 CARMEN AVE
INVER GROVE HEIGHTS MN
55076-4416
US

IV. Provider business mailing address

1399 FELIX ST
SAINT PAUL MN
55118-3207
US

V. Phone/Fax

Practice location:
  • Phone: 651-455-9697
  • Fax:
Mailing address:
  • Phone: 651-457-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21669
License Number StateMN

VIII. Authorized Official

Name: JANE E VANROEKEL
Title or Position: OWNER-MEDICAL DIRECTOR
Credential: MD
Phone: 651-455-9697