Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | CNP 4749 | MN |
NPI | 1023564150 |
---|---|
Provider Name | Melissa Lee Jones |
First Address | Maplewood, MN 55109-2186 |
Second Address | Minneapolis, MN 55408-2077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 24/03/2017 |