Healthcare Provider Details

I. General information

NPI: 1023098837
Provider Name (Legal Business Name): JESSICA L NYHOLM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 HOSPITAL DR STE 270
MAPLE GROVE MN
55369-4820
US

IV. Provider business mailing address

9825 HOSPITAL DR STE 270
MAPLE GROVE MN
55369-4820
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-5140
  • Fax:
Mailing address:
  • Phone: 763-581-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number45811
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: