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General NPI Number Information
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NPI Number | 1245461441
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Entity Type | Individual
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Provider Name | JESSICA THANE ZALDIVAR RN CNP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 1200 LAGOON AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2077
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Country | US
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Telephone | 612-821-6157
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Fax |
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Provider Business Mailing Address
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Address Line | 4243 PLEASANT AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55409-1919
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Country | US
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Telephone | 612-803-9462
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 172132-0
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License Number State | MN
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