Provider Demographics
NPI:1316232895
Name:NIEUWBOER, JESSICA RAE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RAE
Last Name:NIEUWBOER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 VALLEY CREEK PLZ
Mailing Address - Street 2:T-0694
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2265
Mailing Address - Country:US
Mailing Address - Phone:651-735-9517
Mailing Address - Fax:651-735-9517
Practice Address - Street 1:7200 VALLEY CREEK PLZ
Practice Address - Street 2:T-0694
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2265
Practice Address - Country:US
Practice Address - Phone:651-735-9517
Practice Address - Fax:651-735-9517
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN119418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist