Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R1533356 | MN |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R1533356 | MN |
NPI | 1134312747 |
---|---|
Provider Name | Heather M Jaynes |
First Address | Roseville, MN 55113-1182 |
Second Address | St. Paul, MN 55102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 28/11/2012 |