Doctor Name: | MS. JEAN FAY KING |
NPI Number: | 1114383437 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | CNP 4247 |
Business Practice Address: | 657 E Main St Anoka, MN - 553032528 |
Business Phone Number: | 7632440410 |
Business Fax Number: | |
Mailing Address: | 11442 Oregon Ave N, CHAMPLIN |
State: | MN |
Postal Code: | 553162865 |
Phone Number: | 7632440410 |
Fax Number: | |
NPI Enumeration Date: | 01/04/2016 |
NPI Last Update Date: | 01/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CNP 4247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |