Provider Demographics
NPI:1578852315
Name:JAKUBOWSKI, KRISTIN BUCKNER
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:BUCKNER
Last Name:JAKUBOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:FISHER
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17705 HUTCHINS DR STE 250
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4103
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:952-401-8242
Practice Address - Street 1:17705 HUTCHINS DR STE 250
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4103
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:952-401-8242
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics