Provider Demographics
NPI:1376959924
Name:JEZORSKI, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JEZORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 MCDONALD DRIVE CT N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2126
Mailing Address - Country:US
Mailing Address - Phone:651-270-1589
Mailing Address - Fax:
Practice Address - Street 1:3900 NORTHWOODS DR STE 240
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6991
Practice Address - Country:US
Practice Address - Phone:651-633-7300
Practice Address - Fax:651-633-7301
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 124770-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse