Individual
JACKSON PENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 DELAWARE STREET SE, MMC 292, MINNEAPOLIS, MN 55455
(612) 626-5589
Mailing address
420 DELAWARE ST SE, MINNEAPOLIS, MN 55455-0341
(612) 626-5589
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/08/2022
Last updated
05/13/2024
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