MEDICARE: ASIA JACKSON

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	374J00000X	Doula		MN

General Provider Information

NPI Number	:	1134094691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASIA JACKSON

Provider Business Mailing Address
First Line	:	5415 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1927
Country	:	US
Telephone Number	:	612-556-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1927
Country	:	US
Telephone Number	:	612-556-9544
Fax Number	:

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

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	02/03/2026

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Directions to “ ASIA JACKSON ” Practice Location

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