Provider Demographics
NPI:1922054402
Name:SASSENFELD, JANE R (CNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:SASSENFELD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6005
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:2810 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4708
Practice Address - Country:US
Practice Address - Phone:612-873-6005
Practice Address - Fax:612-630-8242
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-1499704363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN981472800Medicaid
MN40D85HAOtherBLUE CROSS BLUE SHIELD
MN07-02029OtherMEDICA
MN07-02029OtherMEDICA
MN981472800Medicaid
MNP27986Medicare UPIN