Provider Demographics
NPI:1811376304
Name:PEARSON, JENNIFER (CD(DONA))
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PELLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 18657
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-0657
Mailing Address - Country:US
Mailing Address - Phone:651-245-5504
Mailing Address - Fax:
Practice Address - Street 1:3424 HIGHCREST RD NE
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-1757
Practice Address - Country:US
Practice Address - Phone:651-245-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9378374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula