MEDICARE: JODI ANN EGELAND MSN, 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	363LF0000X	Family Nurse Practitioner	R1264890	MN

General Provider Information

NPI Number	:	1619961216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI ANN EGELAND MSN, CNP

Provider Business Mailing Address
First Line	:	600 MAYWOOD AVE
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-7008
Country	:	US
Telephone Number	:	507-389-6276
Fax Number	:	507-389-5787

Provider Business Practice Location Address
First Line	:	600 MAYWOOD AVE
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-7008
Country	:	US
Telephone Number	:	507-389-6276
Fax Number	:	507-389-5787

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/01/2023

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