Provider Demographics
NPI:1508217092
Name:MINN, JENNIFER (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MINN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3412
Mailing Address - Country:US
Mailing Address - Phone:510-655-4000
Mailing Address - Fax:
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-655-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA778995163W00000X
NY693805163W00000X
NY382730363LP0200X
CANP95009113363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse