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General NPI Number Information
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NPI Number | 1912122797
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Entity Type | Individual
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Provider Name | JENEFER JUNE SOUTHWICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/15/2025
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Provider Practice Location Address
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Address Line | 7545 VETERANS DR
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City | RAMSEY
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State | MN
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Zip | 55303-7500
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Country | US
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Telephone | 612-467-1100
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Fax | 763-421-2067
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Provider Business Mailing Address
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Address Line | 7545 VETERANS DR
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City | RAMSEY
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State | MN
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Zip | 55303-7500
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Country | US
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Telephone | 612-467-1100
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Fax | 634-227-6377
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7977
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License Number State | MN
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