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Individual

JOCELYN CHECCO DE SOUZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN, FNP-BC

Contact information

Practice address
810 4TH AVE S, SUITE 101, MOORHEAD, MN 56560-2800
(218) 236-6502
Mailing address
14856 VICTORY LN, LAKE PARK, MN 56554-9135
(763) 639-4737

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
700352
TX
363LF0000X
Family Nurse Practitioner
Primary
R201278-2
MN
363LF0000X
Family Nurse Practitioner
R38151
ND

Other

Enumeration date
01/14/2008
Last updated
11/20/2013
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