Provider Demographics
NPI:1871835025
Name:RALPH, JESSIKA (MD)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:RALPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:
Other - Last Name:HOPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:606 24TH AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1437
Mailing Address - Country:US
Mailing Address - Phone:612-273-7111
Mailing Address - Fax:
Practice Address - Street 1:606 24TH AVE S STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1437
Practice Address - Country:US
Practice Address - Phone:612-273-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.142418207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program