Healthcare Provider Details

I. General information

NPI: 1376567404
Provider Name (Legal Business Name): JENNIFER DART RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 DATA PARK MN006-W600
MINNETONKA MN
55343-9026
US

IV. Provider business mailing address

3433 BROADWAY ST NE STE 300
MINNEAPOLIS MN
55413-1761
US

V. Phone/Fax

Practice location:
  • Phone: 800-896-8936
  • Fax: 888-866-3209
Mailing address:
  • Phone: 763-587-7737
  • Fax: 763-587-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR162523-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: