Provider Demographics
NPI:1275305153
Name:HOWARD, JACQUELINE RENAE (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RENAE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15151 IGUANA ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-7134
Mailing Address - Country:US
Mailing Address - Phone:763-222-5016
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9632
Practice Address - Country:US
Practice Address - Phone:763-222-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2279363163W00000X
MN11105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse