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General NPI Number Information
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NPI Number | 1538691043
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Entity Type | Individual
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Provider Name | JENIFER FLEGEL
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Gender | Female
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 963 ROBERT ST S
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-1446
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Country | US
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Telephone | 651-726-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 963 SOUTH ROBERT STREET
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-1446
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | CNP 5078
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License Number State | MN
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