Provider Demographics
NPI:1477585222
Name:NORTON, JESSICA A (PAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:NORTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:RUTZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19021 FREEPORT ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1278
Mailing Address - Country:US
Mailing Address - Phone:763-645-3313
Mailing Address - Fax:763-432-7544
Practice Address - Street 1:19021 FREEPORT ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1278
Practice Address - Country:US
Practice Address - Phone:763-645-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
141285OtherUCARE
964851028877OtherP ONE
0120726OtherMEDICA
156615600OtherNEW MA PROVIDER NUMBER
P00232858OtherRAILROAD MEDICARE
381K3RUOtherBCBS
970002200OtherMETRAHEALTH MPIN
P00232858OtherRAILROAD MEDICARE
MN9700002200Medicare ID - Type Unspecified