Individual
JEAN THOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-5000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
169566-22
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
913542100
—
MN
Enumeration date
01/03/2006
Last updated
02/21/2013
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