Healthcare Provider Details

I. General information

NPI: 1003268772
Provider Name (Legal Business Name): BREE YAEGER JENSEN DNP, APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 RIDGEWOOD CV
MINNETRISTA MN
55364-8239
US

IV. Provider business mailing address

1634 HILLCREST AVE
SAINT PAUL MN
55116-2147
US

V. Phone/Fax

Practice location:
  • Phone: 612-865-5262
  • Fax:
Mailing address:
  • Phone: 651-331-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP 4596
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: