Healthcare Provider Details

I. General information

NPI: 1861830275
Provider Name (Legal Business Name): ALISSA JO HOBAN APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISSA JO JASKEN

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 PLEASANT AVE S
PARK RAPIDS MN
56470-1440
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-732-2800
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1898020
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number33740
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1801
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: