Provider Demographics
NPI:1073341228
Name:WILLEMS, JENNIFER JOY (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:WILLEMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 COLORADO AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1220
Mailing Address - Country:US
Mailing Address - Phone:952-546-5322
Mailing Address - Fax:
Practice Address - Street 1:1342 COLORADO AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1220
Practice Address - Country:US
Practice Address - Phone:952-546-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner