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General NPI Number Information
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NPI Number | 1619502960
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Entity Type | Individual
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Provider Name | HANNAH E JUETTNER
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Gender | Female
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1736 COPE AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55109-2610
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Country | US
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Telephone | 651-770-3831
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Fax |
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Provider Business Mailing Address
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Address Line | 601 MENAUL BLVD NE UNIT 702
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1564
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Country | US
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Telephone | 502-645-3317
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 14613
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License Number State | MN
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