Healthcare Provider Details

I. General information

NPI: 1285140442
Provider Name (Legal Business Name): JESSICA MAE BRABENDER APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MAE BYRNES

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

3850 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3123
  • Fax:
Mailing address:
  • Phone: 952-993-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5561
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: