Individual
JEREMY JAY WALDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
111 COUNTY ROAD 11 NW, PINE ISLAND, MN 55963-9756
(507) 356-4929
Mailing address
111 COUNTY ROAD 11 NW, PINE ISLAND, MN 55963-9756
(507) 356-4929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R1432965
MN
Other
Enumeration date
06/13/2011
Last updated
06/13/2011
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