Provider Demographics
NPI:1215999768
Name:KANTER, JEANNIE D (RN, CNP, AE-C)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:D
Last Name:KANTER
Suffix:
Gender:F
Credentials:RN, CNP, AE-C
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:D
Other - Last Name:SEVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:1110 YANKEE DOODLE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2092
Practice Address - Country:US
Practice Address - Phone:651-454-3970
Practice Address - Fax:551-241-0059
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0849083363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN142227800Medicaid
S46818Medicare UPIN
MN142227800Medicaid