MS. JEANINE MARIE EDSTROM (NPI# 1447560693) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1447560693 |
Entity Type | Individual |
Full Name | MS. JEANINE MARIE EDSTROM |
Other Name | JEANINE MARIE WORMS |
Credential | PAC |
Practice Address |
1185 Town Centre Dr Ste 200 Eagan MN 55123-1343 |
Mailing Address |
Po Box 14909 Minneapolis MN 55414-0909 |
Practice Telephone | 6128711145 |
Practice Fax Number | 6128705491 |
Mailing Telephone | 6128711145 |
Mailing Fax Number | 6128705491 |
Enumeration Date | 2010-10-20 |
Last Update Date | 2013-03-20 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
1504 | MN | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
1185 TOWN CENTRE DR STE 200 |
City | EAGAN |
State | MN |
Zip Code | 55123-1343 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053828467 | Hilltop Family Chiropractic Center Pa | Chiropractor | 1121 Town Centre Drive Suite 202, Eagan, MN 55123 | 2018-01-08 |
1922452507 | Jacob Zimmerman | Counselor | 3450 O'leary Ln., Eagan, MN 55123 | 2016-04-20 |
1316320971 | K-squared Fitness, L.L.C. | Public Health or Welfare | 1100 Cliff Rd, Eagan, MN 55123 | 2015-07-01 |
1346683687 | Joshua M Dorn | Allergy & Immunology | 3460 Promenade Ave, Eagan, MN 55123 | 2013-04-16 |
1700172350 | Mary Christine Mcnabney | Nurse Practitioner | 610 Opperman Drive, D4 Health Center, Your Wellbeing Health Center, Eagan, MN 55123 | 2011-06-22 |
1033353669 | Todd Borstad | Social Worker | 3450 O'leary Lane, Eagan, MN 55123 | 2009-04-27 |
1821025271 | Mngi Endoscopy LLC | Clinic/Center | 1185 Town Centre Drive, Eagan, MN 55123 | 2006-06-28 |
1780620120 | Cindy Eileen Wood | Audiologist | 3440 Oleary Lane, 240, Eagan, MN 55123 | 2006-06-22 |
1609845742 | Jeffery R Dichter | Internal Medicine | 849 Govern Circle, Saint Paul, MN 55123 | 2006-03-14 |
1891269155 | Elise Broderick Quam | Social Worker | 3450 Oleary Ln, Eagan, MN 55123 | 2019-01-18 |
Find all providers in zip 55123 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457831331 | Andrea Horsch | Physician Assistant | 2620 Eagan Woods Dr, Eagan, MN 55121-1138 | 2018-08-20 |
1447682679 | Kathryn L Roggow | Physician Assistant | 2620 Eagan Woods Dr Ste 100, Eagan, MN 55121-1138 | 2013-07-30 |
1457582793 | Matthew R Wolden | Physician Assistant | 2620 Eagan Woods Dr Ste 100, Eagan, MN 55121-1138 | 2009-08-04 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194120204 | Nathan C Clapper | Physician Assistant | 3580 Arcade St Ste 100, Vadnais Heights, MN 55127-7135 | 2014-10-31 |
1003180555 | Elizabeth K Saterenzoller | Physician Assistant | 1015 Marsh Street, Mankato, MN 56002-8673 | 2012-03-01 |
1477824472 | Andrea Jo Pitzl | Physician Assistant | 3208 36th Ave Ne, St Anthony, MN 55418-1713 | 2012-01-23 |
1841504792 | Michelle R Aumock | Physician Assistant | 8100 W 78th Street, Ste 230, Edina, MN 55439 | 2010-08-03 |
1194042390 | Gerald Frederick Anderson | Physician Assistant | 4060 Haines Rd, #104, Duluth, MN 55811-1746 | 2010-04-27 |
1558683904 | Oswaldo Serge | Physician Assistant | 4036 3rd St Nw, Rochester, MN 55901-7564 | 2010-02-25 |
1417288945 | Amanda Kay Johnson | Physician Assistant | 201 W Center St Ei-01 Surgical Assistant, Rochester, MN 55902-3003 | 2010-01-22 |
1790922755 | Jenelle Cecilia Rock | Physician Assistant | 1950 Northwestern Ave S, Suite 102, Stillwater, MN 55082-7590 | 2009-01-13 |
1174775514 | Nathan J Nistler | Physician Assistant | 3580 Arcade Stq, Vadnais Heights, MN 55127-7135 | 2008-10-16 |
1811164007 | Leah Anne Zupancich | Physician Assistant | 2545 Chicago Ave. S., Suite 106, Minneapolis, MN 55404 | 2008-05-15 |
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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.