Provider Demographics
NPI:1184341984
Name:LINDBERG, JASMIN NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:NICOLE
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:NICOLE
Other - Last Name:BRETOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9245 QUANTRELLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-0168
Mailing Address - Country:US
Mailing Address - Phone:763-746-9492
Mailing Address - Fax:
Practice Address - Street 1:9245 QUANTRELLE AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-0168
Practice Address - Country:US
Practice Address - Phone:763-746-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant