Provider Demographics
NPI:1265868624
Name:HERTHER, JENNIFER LIN (APN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LIN
Last Name:HERTHER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LIN
Other - Last Name:DENNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 NORTHDALE BLVD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-6713
Mailing Address - Country:US
Mailing Address - Phone:202-715-7900
Mailing Address - Fax:202-544-4393
Practice Address - Street 1:3495 NORTHDALE BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-6713
Practice Address - Country:US
Practice Address - Phone:763-323-4127
Practice Address - Fax:763-401-6353
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010700363LA2200X
MN5802363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health