Provider Demographics
NPI:1528099553
Name:MCCROSSEN, JANE (RN CNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MCCROSSEN
Suffix:
Gender:F
Credentials:RN CNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3833 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2697
Mailing Address - Country:US
Mailing Address - Phone:763-427-8320
Mailing Address - Fax:763-302-4338
Practice Address - Street 1:3833 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2697
Practice Address - Country:US
Practice Address - Phone:763-427-8320
Practice Address - Fax:763-302-4338
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 104826-5363L00000X
MN0221364-21363LA2200X
MN95231363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013464OtherPREFERRED ONE
MN2444868OtherAMERICA'S PPO
MN410568OtherMEDICA
MN116351OtherUCARE
MN398524500Medicaid
MNHP17968OtherHEALTHPARTNERS
MN7K968MCOtherBCBS OF MN
WI36018300Medicaid
MN1013464OtherPREFERRED ONE
MN500000108Medicare ID - Type UnspecifiedMN MEDICARE