Provider Demographics
NPI:1285628784
Name:PLESTED, JEAN FRANCES (MSN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:FRANCES
Last Name:PLESTED
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:FRANCES
Other - Last Name:MAUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:16619 GILBERT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6148
Mailing Address - Country:US
Mailing Address - Phone:218-829-8618
Mailing Address - Fax:
Practice Address - Street 1:900 NICOLLET MALL
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2530
Practice Address - Country:US
Practice Address - Phone:612-659-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0773007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03660Medicare ID - Type Unspecified