MEDICARE: JENNIFER RAE EGGERS PA

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
1	363A00000X	Physician Assistant	10080	MN

General Provider Information

NPI Number	:	1073589123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RAE EGGERS PA

Provider Business Mailing Address
First Line	:	8100 34TH AVE S
Second Line	:	MC21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-1672
Country	:	US
Telephone Number	:	952-883-7172
Fax Number	:	952-883-5395

Provider Business Practice Location Address
First Line	:	5100 GAMBLE DR
Second Line	:	SUITE 100
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1521
Country	:	US
Telephone Number	:	952-541-2500
Fax Number	:	952-541-2626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	04/09/2014

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