Individual
MR. JACOB ANDREW KINGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
14700 28TH AVE N STE 20, PLYMOUTH, MN 55447-4876
(763) 559-3779
Mailing address
PO BOX 47159, PLYMOUTH, MN 55447-0159
(763) 559-3779
(763) 450-3986
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2630
MN
Other
Enumeration date
06/04/2021
Last updated
05/30/2024
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