Goembel, Jesse L

Goembel, Jesse L is an individual health care provider with primary practice located at 550 Osborne Rd Ne , Fridley MN 55432-2718. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Goembel, Jesse L can be contacted via phone (763) 236-5000.

Contact Information

Primary practice address
550 Osborne Rd Ne Fridley MN 55432-2718
Phone: (763) 236-5000
Fax: (763) 236-3516
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0643 South Dakota

Profile Details

NPI number 1356486963
LBN Legal business name Goembel, Jesse L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 21st, 2007
Last updated Nov 10th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356486963 NPPES
Minnesota Other 1238 MN TEMPORARY LICENSE
Minnesota MEDICAID 6829150 MN TEMPORARY LICENSE
Minnesota Other 0643 MN TEMPORARY LICENSE

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