Healthcare Provider Details

I. General information

NPI: 1386273944
Provider Name (Legal Business Name): JAYSON ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH ST W
SAINT PAUL MN
55102-1062
US

IV. Provider business mailing address

2370 CAROL DR NE
BEMIDJI MN
56601-5265
US

V. Phone/Fax

Practice location:
  • Phone: 218-407-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4159
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: