Healthcare Provider Details

I. General information

NPI: 1295777290
Provider Name (Legal Business Name): JONATHAN DAVID GAIR MA, BSN, PHN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W 44TH ST
MINNEAPOLIS MN
55409-1703
US

IV. Provider business mailing address

901 W 44TH ST
MINNEAPOLIS MN
55409-1703
US

V. Phone/Fax

Practice location:
  • Phone: 612-825-0413
  • Fax:
Mailing address:
  • Phone: 612-825-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR 160600-5
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR-160600-5
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberR-160600-5
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR-160600-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: