Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP 4596 | MN |
NPI | 1003268772 |
---|---|
Provider Name | Mrs. Bree Yaeger Jensen |
First Address | Saint Paul, MN 55116-2147 |
Second Address | Minnetrista, MN 55364-8239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2016 |
Last Update Date | 06/07/2016 |