Healthcare Provider Details

I. General information

NPI: 1336720366
Provider Name (Legal Business Name): JENNIFER LOUISE EMBRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LOUISE OSBURN

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S MAPLE ST STE 130
WACONIA MN
55387-1793
US

IV. Provider business mailing address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-2137
  • Fax:
Mailing address:
  • Phone: 919-966-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number78948
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: