Provider Demographics
NPI:1487644134
Name:NOTSCH, JEANNE M (CNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:NOTSCH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4917
Mailing Address - Fax:320-229-5181
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:320-229-4917
Practice Address - Fax:320-229-5181
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1076729363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
648318600OtherMEDICAL ASSISTANCE (MA)
110931OtherU-CARE
R1076729OtherMN LICENSE #
HP22752OtherHEALTH PARTNERS
2116656OtherFIRST HEALTH PLAN
86D75NOOtherBLUE CROSS BLUE SHIELD
0403678OtherMEDICA HEALTH PLANS
1001215OtherPREFERRED ONE
2116656OtherFIRST HEALTH PLAN
0403678OtherMEDICA HEALTH PLANS