Provider Demographics
NPI:1356321467
Name:TEMPLE, JEFFERY J (NP)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:J
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GOLF COURSE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3526
Mailing Address - Country:US
Mailing Address - Phone:218-326-8749
Mailing Address - Fax:218-326-0400
Practice Address - Street 1:111 GOLF COURSE RD
Practice Address - Street 2:STE 1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3526
Practice Address - Country:US
Practice Address - Phone:218-326-8749
Practice Address - Fax:218-326-0400
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN0359861363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP49668OtherHEALTH PARTNERS
MN849650100Medicaid
MN982221028303OtherPREFERRED ONE
MN143435OtherU CARE
MNNO10804OtherCHAMPUS
MN849650100OtherITASCA MEDICAL CARE
MN0106837OtherMEIDCA
MN41B60TEOtherBCBS
MN500026265OtherRAILROAD MEDICARE
MN849650100OtherITASCA MEDICAL CARE
MN41B60TEOtherBCBS