Provider Demographics
NPI:1710233036
Name:LOHONEN, JACQUELINE MONIQUE (NP C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MONIQUE
Last Name:LOHONEN
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 149TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6433
Mailing Address - Country:US
Mailing Address - Phone:651-270-7975
Mailing Address - Fax:
Practice Address - Street 1:1500 109TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4670
Practice Address - Country:US
Practice Address - Phone:651-631-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF0712367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily