Provider Demographics
NPI:1396045373
Name:NESTANDE, JODENE LYNN (PT)
Entity type:Individual
Prefix:
First Name:JODENE
Middle Name:LYNN
Last Name:NESTANDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODENE
Other - Middle Name:LYNN
Other - Last Name:NEGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1939 MINNEHAHA AVE W STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1033
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:651-748-2892
Practice Address - Street 1:601 CENTRAL AVE W STE 102
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376
Practice Address - Country:US
Practice Address - Phone:763-595-1300
Practice Address - Fax:763-276-1190
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650002666Medicare UPIN