Individual
JESSICA M STAPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8290 UNIVERSITY AVE NE STE 200, FRIDLEY, MN 55432-1876
(763) 786-9543
(763) 786-3320
Mailing address
8290 UNIVERSITY AVE NE STE 200, FRIDLEY, MN 55432-1876
(763) 786-9543
(763) 786-3320
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10271
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356544274
—
MN
Enumeration date
06/07/2007
Last updated
10/02/2018
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