Provider Demographics
NPI:1922455591
Name:PERRY, JESSICA ANN (DNP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:PERRY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 GALLAGHER DR
Mailing Address - Street 2:APT # 333
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4529
Mailing Address - Country:US
Mailing Address - Phone:218-849-0698
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MNCNP 4627363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program