Provider Demographics
NPI:1851816623
Name:BESTA, JENNIFER DEE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DEE
Last Name:BESTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DEE
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2506 BITTERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2102
Mailing Address - Country:US
Mailing Address - Phone:605-360-8790
Mailing Address - Fax:
Practice Address - Street 1:2506 BITTERSWEET LN
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2102
Practice Address - Country:US
Practice Address - Phone:605-360-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-2205971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR-2205971OtherMN BOARD OF NURSING