Provider Demographics
NPI:1447204383
Name:WEBB, JOLENE PETERSEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:PETERSEN
Last Name:WEBB
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 1:425 ELM ST N
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - SAUK CENTRE
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1010
Mailing Address - Country:US
Mailing Address - Phone:320-352-6591
Mailing Address - Fax:320-352-5164
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-5099
Practice Address - Fax:320-229-5022
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001268363A00000X
MN11074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant