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NPI Code Detail

MEDICARE: JERMAINE CULDRICK ROBERTSON

MEDICARE: JERMAINE CULDRICK ROBERTSON
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1245027648
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERMAINE CULDRICK ROBERTSON
Provider Business Mailing Address
First Line : 701 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55415-1623
Country : US
Telephone Number : 631-874-3000
Fax Number : 631-874-3000
Provider Business Practice Location Address
First Line : 2810 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-4708
Country : US
Telephone Number : 613-873-8084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2025
Last Update Date : 06/22/2026

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Directions to “ JERMAINE CULDRICK ROBERTSON ” Practice Location

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