Individual
JESSE LEE FLADMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
1654 DIFFLEY RD, 100, EAGAN, MN 55122-2237
(651) 641-3900
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12157
MN
Other
Enumeration date
10/06/2011
Last updated
05/19/2023
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