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NPI Code Detail

MEDICARE: JENNIFER A FLAHERTY PA

MEDICARE: JENNIFER A FLAHERTY 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
1363AS0400XSurgical Physician Assistant10917MN
2363A00000XPhysician Assistant1874023WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598746513
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER A FLAHERTY PA
Provider Business Mailing Address
First Line : 909 FULTON ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-4800
Country : US
Telephone Number : 612-672-7100
Fax Number :
Provider Business Practice Location Address
First Line : 909 FULTON ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55455-4800
Country : US
Telephone Number : 612-672-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 12/05/2023

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Directions to “ JENNIFER A FLAHERTY PA” Practice Location

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