Provider Demographics
NPI:1316960305
Name:ABBOTT NORTHWESTERN HOSPITAL
Entity type:Organization
Organization Name:ABBOTT NORTHWESTERN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:CHERYLE
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:JESINOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-863-4478
Mailing Address - Street 1:4165 CASHELL GLN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2819
Mailing Address - Country:US
Mailing Address - Phone:651-251-3052
Mailing Address - Fax:
Practice Address - Street 1:4165 CASHELL GLN
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55122-2819
Practice Address - Country:US
Practice Address - Phone:651-251-3053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR090636-6282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access