Healthcare Provider Details

I. General information

NPI: 1619961216
Provider Name (Legal Business Name): JODI ANN EGELAND MSN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAYWOOD AVE
MANKATO MN
56001-7008
US

IV. Provider business mailing address

600 MAYWOOD AVE
MANKATO MN
56001-7008
US

V. Phone/Fax

Practice location:
  • Phone: 507-389-6276
  • Fax: 507-389-5787
Mailing address:
  • Phone: 507-389-6276
  • Fax: 507-389-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0727
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1264890
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: