Mikkelson, Jody Ann
Mikkelson, Jody Ann is an individual health care provider with primary practice located at 9825 Hospital Dr Ste 300 , Maple Grove MN 55369-4768. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Mikkelson, Jody Ann can be contacted via phone (763) 587-7900.Contact Information
Primary practice address
9825 Hospital Dr Ste 300
Maple Grove MN 55369-4768
Phone: (763) 587-7900
Fax: (763) 494-7501
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 9584 | Minnesota |
Profile Details
| NPI number | 1669400156 |
|---|---|
| LBN Legal business name | Mikkelson, Jody Ann |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 30th, 2006 |
| Last updated | Nov 8th, 2022 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669400156 | NPPES |
| Minnesota | MEDICAID | 201932900 |
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