Individual
MR. KELLY PAUL JESOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
6465 WAYZATA BLVD STE 150, MINNEAPOLIS, MN 55426-1750
(763) 546-8899
Mailing address
610 265TH AVE NE, ISANTI, MN 55040-5258
(612) 513-5803
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
814568
MN
Other
Enumeration date
04/27/2023
Last updated
04/27/2023
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