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General NPI Number Information
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NPI Number | 1164361747
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Entity Type | Individual
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Provider Name | JESSICA ANN PEHRSON
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Gender | Female
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 230 MAHTOMEDI AVE
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1635
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Country | US
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Telephone | 651-795-1935
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Fax |
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Provider Business Mailing Address
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Address Line | 230 MAHTOMEDI AVE
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1635
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Country | US
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Telephone | 651-795-1935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R-1721388
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License Number State | MN
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