Provider Demographics
NPI:1609109982
Name:FASHANT-PETERSON, JESSICA ANNE (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:FASHANT-PETERSON
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 1:6452 CITY WEST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-999-0333
Mailing Address - Fax:952-300-2558
Practice Address - Street 1:6452 CITY WEST PKWY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3245
Practice Address - Country:US
Practice Address - Phone:952-999-0333
Practice Address - Fax:952-300-2558
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR161940-3207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine