Healthcare Provider Details

I. General information

NPI: 1790132652
Provider Name (Legal Business Name): JACKIE VROMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

IV. Provider business mailing address

916 4TH AVE SW
PIPESTONE MN
56164-1890
US

V. Phone/Fax

Practice location:
  • Phone: 507-825-5811
  • Fax:
Mailing address:
  • Phone: 507-825-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-08855
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: