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NPI Code Detail

MEDICARE: JACLYN DEW RN

MEDICARE: JACLYN DEW RN
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
1164W00000XLicensed Practical NurseL725916MN
2163W00000XRegistered Nurse2533213MN

General Provider Information

NPI Number : 1811723513
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN DEW RN
Provider Business Mailing Address
First Line : 15637 115TH AVE
Second Line :
City : OSAKIS
State : MN
Zip : 56360-4558
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 410 30TH AVE E
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-4769
Country : US
Telephone Number : 320-252-1670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2024
Last Update Date : 03/06/2026

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