Provider Demographics
NPI:1588861827
Name:ST.ARNOLD, JENNIFER ANN (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:ST.ARNOLD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:THEIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5953 E MABEL NELSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH RANGE
Mailing Address - State:WI
Mailing Address - Zip Code:54874-8171
Mailing Address - Country:US
Mailing Address - Phone:715-392-9199
Mailing Address - Fax:
Practice Address - Street 1:2900 PIEDMONT AVE
Practice Address - Street 2:SUPERIOR HEALTH CENTER
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-727-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 174692-3163W00000X, 164W00000X
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse