Provider Demographics
NPI:1720414832
Name:DUFOUR, JACQUELINE KAY FORD (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KAY FORD
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SNELLING AVE N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1719
Mailing Address - Country:US
Mailing Address - Phone:651-697-5863
Mailing Address - Fax:
Practice Address - Street 1:2700 SNELLING AVE N
Practice Address - Street 2:SUITE 400
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1719
Practice Address - Country:US
Practice Address - Phone:651-697-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR180766-8367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered