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General NPI Number Information
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NPI Number | 1932960291
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Entity Type | Individual
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Provider Name | JESSICA LYNN HALVERSON CNP
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Gender | Female
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 10150 NIAGARA LN N STE 100
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7588
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Country | US
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Telephone | 763-712-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 UNIVERSITY AVE W STE 110N
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City | SAINT PAUL
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State | MN
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Zip | 55114-2001
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Country | US
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Telephone | 651-602-5309
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2465398
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License Number State | MN
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