| Doctor Name: | JEANANN TJADER |
| NPI Number: | 1558395889 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | R40917-020 |
| Business Practice Address: | 300 W Conan St Ely, MN - 557311145 |
| Business Phone Number: | 2183657900 |
| Business Fax Number: | 2183657975 |
| Mailing Address: | 300 W Conan St, ELY |
| State: | MN |
| Postal Code: | 557311145 |
| Phone Number: | 2183657900 |
| Fax Number: | 2183657975 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 04/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R40917-020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |