Doctor Name: | JEFFERY JA ENSTAD |
NPI Number: | 1104885888 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RN CNP |
License Number: | R 123314 8 |
Business Practice Address: | 101 Willmar Ave Sw Willmar, MN - 56201 |
Business Phone Number: | 3202315000 |
Business Fax Number: | 3202315067 |
Mailing Address: | 101 Willmar Ave Sw, WILLMAR |
State: | MN |
Postal Code: | 56201 |
Phone Number: | 3202315000 |
Fax Number: | 3202315067 |
NPI Enumeration Date: | 03/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R 123314 8 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |