Healthcare Provider Details

I. General information

NPI: 1033283221
Provider Name (Legal Business Name): JENNIFER LYNN KOBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 9TH ST N
VIRGINIA MN
55792-2329
US

IV. Provider business mailing address

1101 9TH ST N
VIRGINIA MN
55792-2329
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-0150
  • Fax:
Mailing address:
  • Phone: 218-741-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR144528-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: