Provider Demographics
NPI:1689435729
Name:ROSDHAL, JEAN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:ROSDHAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20955 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4968
Mailing Address - Country:US
Mailing Address - Phone:612-481-4663
Mailing Address - Fax:
Practice Address - Street 1:1726 7TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5711
Practice Address - Country:US
Practice Address - Phone:763-634-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily