Provider Demographics
NPI:1043552896
Name:JESSO, TWILA (CNP)
Entity Type:Individual
Prefix:
First Name:TWILA
Middle Name:
Last Name:JESSO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TWIL
Other - Middle Name:
Other - Last Name:KLASEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:43500 MIGIZI DR
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-2241
Mailing Address - Country:US
Mailing Address - Phone:320-532-4163
Mailing Address - Fax:
Practice Address - Street 1:43500 MIGIZI DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-2241
Practice Address - Country:US
Practice Address - Phone:320-532-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188626-5163WP0200X
MNCNP 2811363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics