Healthcare Provider Details

I. General information

NPI: 1316879737
Provider Name (Legal Business Name): JESSICA GORR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W FAIRVIEW ST
SPRING VALLEY MN
55975-1025
US

IV. Provider business mailing address

109 W FAIRVIEW ST
SPRING VALLEY MN
55975-1025
US

V. Phone/Fax

Practice location:
  • Phone: 507-701-7419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2468780
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: