Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | CNP 2811 | MN |
NPI | 1043552896 |
---|---|
Provider Name | Twila Jesso |
First Address | Onamia, MN 56359-2241 |
Second Address | Onamia, MN 56359-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 05/10/2015 |