MEDICARE: JEANNE M NOTSCH CNP

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	363LA2200X	Adult Health Nurse Practitioner	R1076729	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	648318600	OTHER	MEDICAL ASSISTANCE (MA)
2	110931	OTHER	U-CARE
3	R1076729	OTHER	MN LICENSE #
4	HP22752	OTHER	HEALTH PARTNERS
5	2116656	OTHER	FIRST HEALTH PLAN
6	86D75NO	OTHER	BLUE CROSS BLUE SHIELD
7	0403678	OTHER	MEDICA HEALTH PLANS
8	1001215	OTHER	PREFERRED ONE

General Provider Information

NPI Number	:	1487644134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE M NOTSCH CNP

Provider Business Mailing Address
First Line	:	1900 CENTRACARE CIR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-229-4917
Fax Number	:	320-229-5181

Provider Business Practice Location Address
First Line	:	1900 CENTRACARE CIR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-229-4917
Fax Number	:	320-229-5181

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	06/20/2008

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Directions to “ JEANNE M NOTSCH CNP” Practice Location

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