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NPI Code Detail

MEDICARE: CHRISTINE PHAN JERABEK PA

MEDICARE: CHRISTINE PHAN JERABEK 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
1363A00000XPhysician Assistant14909MN
2363A00000XPhysician Assistant7902-23WI

General Provider Information

NPI Number : 1619722329
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE PHAN JERABEK PA
Provider Business Mailing Address
First Line : 2720 FAIRVIEW AVE N STE 200
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1306
Country : US
Telephone Number : 651-633-6883
Fax Number : 651-331-3459
Provider Business Practice Location Address
First Line : 2720 FAIRVIEW AVE N STE 200
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1306
Country : US
Telephone Number : 651-633-6883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2024
Last Update Date : 12/11/2025

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Directions to “ CHRISTINE PHAN JERABEK PA” Practice Location

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