Provider Demographics
NPI:1487667465
Name:PRICE, JONELLE ELAINE (PAC)
Entity Type:Individual
Prefix:
First Name:JONELLE
Middle Name:ELAINE
Last Name:PRICE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S STE 4100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:952-831-1551
Mailing Address - Fax:952-831-0725
Practice Address - Street 1:7600 FRANCE AVE S STE 4100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5924
Practice Address - Country:US
Practice Address - Phone:952-831-1551
Practice Address - Fax:952-831-0725
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ71699Medicare UPIN