Individual
JACLYN ROSE ROBLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
PO BOX A, ONAMIA, MN 56359-0807
(320) 532-3154
Mailing address
1016 SEGUNDO DR, GEORGETOWN, TX 78628-1734
(218) 370-9361
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14453
PA-C LICENSE
MN
Enumeration date
03/06/2023
Last updated
04/30/2025
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