Healthcare Provider Details

I. General information

NPI: 1982911004
Provider Name (Legal Business Name): JENNIFER MINA DEISLER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MINA KLING APRN, CNP

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-7647
  • Fax:
Mailing address:
  • Phone: 763-581-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR179679-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: