Prom, Jennifer A

Prom, Jennifer A is an individual health care provider with primary practice located at 619 W Central Entrance , Duluth MN 55811-5448. 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. Prom, Jennifer A can be contacted via phone (218) 249-4987.

Contact Information

Primary practice address
619 W Central Entrance Duluth MN 55811-5448
Phone: (218) 249-4987
Fax: (218) 249-4989
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 4215 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10142 Minnesota

Profile Details

NPI number 1215948781
LBN Legal business name Prom, Jennifer A
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2006
Last updated Dec 16th, 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 1215948781 NPPES
Minnesota MEDICAID 157938000

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