Individual
JENNIFER EXO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11505 36TH AVE N, PLYMOUTH, MN 55441-2304
(763) 509-3800
Mailing address
11505 36TH AVE N, PLYMOUTH, MN 55441-2304
(763) 509-3800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2015011521
MO
208000000X
Pediatrics Physician
Primary
65273
MN
2080P0203X
Pediatric Critical Care Medicine Physician
2015011521
MO
2080P0203X
Pediatric Critical Care Medicine Physician
49064
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96134780
—
CO
Enumeration date
06/16/2009
Last updated
08/20/2019
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