Individual
JENNA STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 365-1000
Mailing address
18032 70TH PL N, MAPLE GROVE, MN 55311-3032
(320) 309-4780
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1866
MN
Other
Enumeration date
12/28/2015
Last updated
03/19/2018
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