=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598908691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ELIZABETH KAISER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2009
-----------------------------------------------------
Last Update Date | 08/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6936 PINE ARBOR DR S STE 100
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55016-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-326-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6936 PINE ARBOR DR S STE 100
-----------------------------------------------------
City | COTTAGE GROVE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55016-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-326-5800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 53042
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------