JENNIFER A PROM (NPI# 1215948781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215948781 |
| Entity Type | Individual |
| Full Name | JENNIFER A PROM |
| Credential | PAC |
| Practice Address |
619 W Central Entrance Duluth MN 55811-5448 |
| Practice Telephone | 2182494987 |
| Practice Fax Number | 2182494989 |
| Mailing Telephone | 2182494987 |
| Mailing Fax Number | 2182494989 |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2019-02-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 4215 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363A00000X | Physician Assistant | 10142 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 157938000 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 109 N 28th St E, Superior, WI 548806548 | 7153953950 | 7153953955 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902153844 | Jennifer Kristin Prom | Nurse Practitioner | 9025 Oakridge Ln, Cedarburg, WI 53012-9388 | 2012-08-09 |
| Street Address |
619 W CENTRAL ENTRANCE |
| City | DULUTH |
| State | MN |
| Zip Code | 55811-5448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771726 | Amanda Marie Leone | Nurse Practitioner | 619 W Central Entrance, Duluth, MN 55811-5448 | 2019-10-16 |
| 1013564616 | Elizabeth M Lafrance | Physician Assistant | 619 W Central Entrance, Duluth, MN 55811-5448 | 2019-08-20 |
| 1437701976 | Kelsea N Pearson | Physician Assistant | 619 W Central Entrance, Duluth, MN 55811-5448 | 2019-07-15 |
| 1205227758 | Camille Rose Ingle | Physician Assistant | 619 W Central Entrance, Duluth, MN 55811-5448 | 2015-02-05 |
| 1043624414 | Karen Lilyquist | Nurse Practitioner | 619 W Central Entrance, Duluth, MN 55811-5448 | 2014-06-13 |
| 1144658063 | Nichole Marie Dorn | Nurse Practitioner | 619 W Central Entrance, Duluth, MN 55811 | 2013-10-31 |
| 1053589259 | St. Luke's Hospital of Duluth | Family Medicine | 619 W Central Entrance, Duluth, MN 55811-5448 | 2008-02-11 |
| 1386838712 | Suzanne Anderson | Nurse Practitioner | 619 W Central Entrance, Duluth, MN 55811-5448 | 2007-08-29 |
| 1508939042 | Lori G W Lindgren | Nurse Practitioner | 619 W Central Entrance, Qcare, Duluth, MN 55811-5448 | 2006-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417515339 | Kyle Olson-merrick | Dentist | 320 W Myrtle St, Ste 100, Duluth, MN 55811 | 2019-06-05 |
| 1184288979 | Pdg, P.a. | Clinic/Center | 4891 Miller Truck Hwy., Suite 100, Hermantown, MN 55811 | 2019-04-26 |
| 1528589843 | Breanna Joy Greenly | Counselor | 4720 Burning Tree Road, Birch Tree Center, Duluth, MN 55811 | 2017-06-28 |
| 1396102398 | Debbie Christian | Registered Nurse | 4815 Burning Tree Rd Suite 100, Duluth, MN 55811 | 2016-01-21 |
| 1831556935 | Megan Marie Paris | Psychologist | 715 East Central Entrance, Duluth, MN 55811 | 2016-01-20 |
| 1740666908 | Angela Fedo | Physical Therapy Assistant | 2101 Trinity Rd, Duluth, MN 55811 | 2015-08-10 |
| 1649657479 | Kayla Stephenson | Specialist/Technologist | 5024 Morris Thomas Road, Hermantown, MN 55811 | 2015-04-30 |
| 1073918843 | Northern Lives Inc. | Assisted Living Facility | 4014 Trinity Road, Duluth, MN 55811 | 2014-10-23 |
| 1114326238 | Donald Hermanson | Specialist/Technologist | 801 Boulder Drive, Apt. 202, Duluth, MN 55811 | 2014-08-14 |
| 1679990857 | Jodie Little | Pharmacist | 801 W. Central Entrance, Shopko Pharmacy 2114, Duluth, MN 55811 | 2014-03-25 |
| Find all providers in zip 55811 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699396622 | Sarah Cheeney | Physician Assistant | 2803 E 8th St, Duluth, MN 55812-1518 | 2020-04-30 |
| 1144841552 | Jake L Mcgraw | Physician Assistant | 2006 N 51st Ave E, Duluth, MN 55804-1251 | 2020-04-27 |
| 1053931451 | Maggie Ferguson | Physician Assistant | 4219 Mcculloch St, Duluth, MN 55804-1934 | 2020-04-26 |
| 1174143093 | Melissa Dybvig | Physician Assistant | 825 N 43rd Ave E, Duluth, MN 55804-1939 | 2020-04-21 |
| 1033667266 | Wossen Adinew Asfaw | Physician Assistant | 3575 Koger Blvd Ste 116, Duluth, GA 30096-7559 | 2016-09-16 |
| 1629457981 | David John Willard | Physician Assistant | 4245 Pleasant Hill Rd, Duluth, GA 30096-6332 | 2015-05-20 |
| 1992065973 | Esther Maria Laucirica | Physician Assistant | 2159 Wynnton Point, Duluth, GA 30097 | 2012-05-23 |
| 1033419155 | Danielle Jackson | Physician Assistant | 1845 Satellite Blvd Nw, Duluth, GA 30097-5256 | 2010-10-22 |
| 1811202534 | Sharon Alston | Physician Assistant | 1580 Boggs Rd, 700, Duluth, GA 30096-1229 | 2010-08-18 |
| 1942496112 | Caroline A Woods | Physician Assistant | 32 E 1st St, Womens Health Ctr, Duluth, MN 55802 | 2007-09-20 |
| Find all providers in DULUTH | ||||
Please comment or provide details below to improve the information on JENNIFER A PROM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.