Individual
JENNIFER A PROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
619 W CENTRAL ENTRANCE, DULUTH, MN 55811-5448
(218) 249-4987
(218) 249-4989
Mailing address
619 W CENTRAL ENTRANCE, DULUTH, MN 55811-5448
(218) 249-4987
(218) 249-4989
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10142
MN
363A00000X
Physician Assistant
4215
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157938000
—
MN
Enumeration date
08/10/2006
Last updated
12/16/2020
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