Healthcare Provider Details

I. General information

NPI: 1104046820
Provider Name (Legal Business Name): JESSICA A HEALY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA L ALEXANDER M.D.

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WILLOW LAKE BLVD SUITE 240
SAINT PAUL MN
55110-5131
US

IV. Provider business mailing address

3316 W 66TH ST STE 200
EDINA MN
55435-2544
US

V. Phone/Fax

Practice location:
  • Phone: 651-770-0110
  • Fax: 651-770-0134
Mailing address:
  • Phone: 952-303-8600
  • Fax: 952-920-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number48236
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: