Provider Demographics
NPI:1134107154
Name:MONSEN, JESSICA M (PA C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MONSEN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC @ MAIN STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA2951032186OtherPREFERRED ONE
MN140K0DEOtherBCBS
41084933956001C206OtherCHAMPUS
MN1723094OtherAMERICAS PPO
MNHP36000OtherHEALTH PARTNERS
MN0119474OtherMEDICA
MN450072500Medicaid
MN142816OtherUCARE
P00106195OtherRR MEDICARE
MN970001727Medicare PIN
MN0119474OtherMEDICA