MEDICARE: JACQUELINE SUZANNE DENISON GETCHIUS B.A.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1093845679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SUZANNE DENISON GETCHIUS B.A.

Provider Business Mailing Address
First Line	:	7320 GALLAGHER DR
Second Line	:	APT. 304
City	:	EDINA
State	:	MN
Zip	:	55435-4527
Country	:	US
Telephone Number	:	612-743-6471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2629
Country	:	US
Telephone Number	:	651-641-0177
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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