Healthcare Provider Details

I. General information

NPI: 1043286743
Provider Name (Legal Business Name): JANE ESTHER ALLEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE ESTHER ELLEFSON

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 NORTH SMITH AVENUE MAIL STOP #70-302, GARDEN VIEW MEDICAL BUILDING
ST. PAUL MN
55102
US

IV. Provider business mailing address

347 NORTH SMITH AVENUE MAIL STOP #70-302, GARDEN VIEW MEDICAL BUILDING
ST. PAUL MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-5230
  • Fax: 651-220-5231
Mailing address:
  • Phone: 651-220-5230
  • Fax: 651-220-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR1084685
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number90033
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: