Individual
DR. JACALYN DICELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14000 NICOLLET AVE, SUITE 100, BURNSVILLE, MN 55337-5790
(952) 428-0200
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
23731
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0371001
PREFERRED ONE
MN
01
—
0702123
MEDICA
MN
05
—
087288100
—
MN
01
—
57F36DI
BLUE SHIELD
MN
01
—
HP10327
HEALTH PARTNERS
MN
Enumeration date
07/25/2006
Last updated
11/21/2011
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