MS. JEANINE MARIE EDSTROM


Address: 1185 Town Centre Dr Ste 200, Eagan, MN 55123-1343
Phone: 6128711145

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).

Provider Overview

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

Taxonomy

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

Office Location

Street Address 1185 TOWN CENTRE DR STE 200
City EAGAN
State MN
Zip Code 55123-1343

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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City EAGAN
Zip Code 55123

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Dataset Information

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.

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