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NPI Code Detail

MEDICARE: JESSICA LEE STAGEBERG N.P.

MEDICARE: JESSICA LEE STAGEBERG N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse PractitionerR173943-5MN

General Provider Information

NPI Number : 1063802155
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LEE STAGEBERG N.P.
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-9000
Fax Number :
Provider Business Practice Location Address
First Line : 755 CROSSROADS CAMPUS DR NE
Second Line :
City : BUFFALO
State : MN
Zip : 55313-5074
Country : US
Telephone Number : 763-684-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2015
Last Update Date : 12/20/2022

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Directions to “ JESSICA LEE STAGEBERG N.P.” Practice Location

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