Provider Demographics
NPI:1881475192
Name:OMDAHL, JESSICA LIN (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIN
Last Name:OMDAHL
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DELMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1599
Mailing Address - Country:US
Mailing Address - Phone:218-463-4732
Mailing Address - Fax:218-463-4778
Practice Address - Street 1:715 DELMORE DR
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1599
Practice Address - Country:US
Practice Address - Phone:218-463-4732
Practice Address - Fax:218-463-4778
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10863363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health