Provider Demographics
NPI:1083296024
Name:LANCETTE, JESICA (MA)
Entity Type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:LANCETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 WOODLANE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3047
Mailing Address - Country:US
Mailing Address - Phone:651-327-0849
Mailing Address - Fax:651-383-4557
Practice Address - Street 1:1687 WOODLANE DR STE 208
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3047
Practice Address - Country:US
Practice Address - Phone:651-327-0849
Practice Address - Fax:651-383-4557
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1649815614OtherGROUP NPI