Provider Demographics
NPI:1760803522
Name:OHLAND, JENNIFER LEE-DUPIC (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE-DUPIC
Last Name:OHLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:DUPIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS: 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-647-2200
Mailing Address - Fax:651-647-2075
Practice Address - Street 1:451 DUNLAP ST N
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4619
Practice Address - Country:US
Practice Address - Phone:651-647-2200
Practice Address - Fax:651-647-2075
Is Sole Proprietor?:No
Enumeration Date:2013-12-21
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant