Provider Demographics
NPI:1376567404
Name:DART, JENNIFER (RN, CNP)
Entity Type:Individual
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First Name:JENNIFER
Middle Name:
Last Name:DART
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Gender:F
Credentials:RN, CNP
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Mailing Address - Street 1:3433 BROADWAY ST NE
Mailing Address - Street 2:STE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-587-7737
Mailing Address - Fax:763-587-7069
Practice Address - Street 1:9701 DATA PARK
Practice Address - Street 2:MN006-W600
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9026
Practice Address - Country:US
Practice Address - Phone:800-896-8936
Practice Address - Fax:888-866-3209
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR162523-5363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4400003-00Medicaid
MN500002752Medicare ID - Type Unspecified
MN4400003-00Medicaid