Healthcare Provider Details

I. General information

NPI: 1841169414
Provider Name (Legal Business Name): JENNIFER SALAZAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR STE 1340
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR STE 1340
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-5105
  • Fax: 320-200-3207
Mailing address:
  • Phone: 320-229-5105
  • Fax: 320-200-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2526188
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: