Provider Demographics
NPI:1396560801
Name:BEDARD-PARKER, JENNIFER DUBEAU (PMHNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DUBEAU
Last Name:BEDARD-PARKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3306
Mailing Address - Country:US
Mailing Address - Phone:651-842-3003
Mailing Address - Fax:
Practice Address - Street 1:752 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3306
Practice Address - Country:US
Practice Address - Phone:651-842-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11914363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health