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General NPI Number Information
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NPI Number | 1649328121
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Entity Type | Individual
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Provider Name | JENNIFER MARIE KULUS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FAIRVIEW URGENT CARE - EAGAN 1440 DUCKWOOD DRIVE
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City | EAGAN
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State | MN
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Zip | 55122
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Country | US
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Telephone | 651-406-8860
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Fax | 651-406-8870
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Provider Business Mailing Address
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Address Line | 19957 DOVER DRIVE
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City | FARMINGTON
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State | MN
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Zip | 55024
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Country | US
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Telephone | 651-463-2323
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1068165
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License Number State | MN
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