MEDICARE: MRS. JENNIFER L BARHOOVER RN, 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	363LP0200X	Pediatric Nurse Practitioner	R 171740-2	MN

General Provider Information

NPI Number	:	1992030217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L BARHOOVER RN, CNP

Provider Business Mailing Address
First Line	:	2530 CHICAGO AVE
Second Line	:	MAIL STOP 32-T6300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4570
Country	:	US
Telephone Number	:	612-813-7664
Fax Number	:	612-813-6889

Provider Business Practice Location Address
First Line	:	2530 CHICAGO AVE
Second Line	:	MAIL STOP 32-T6300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4570
Country	:	US
Telephone Number	:	612-813-7664
Fax Number	:	612-813-6889

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

Provider Enumeration Date	:	10/04/2009
Last Update Date	:	10/04/2009

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