Individual
JENNIFER ANN COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1431 PREMIER DR, MANKATO, MN 56001-6076
(507) 386-6600
(507) 625-5971
Mailing address
1431 PREMIER DR, MANKATO, MN 56001-6076
(507) 386-6600
(507) 625-5971
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1468
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710292321
BCBS OF MN
MN
05
—
1710292321
—
MN
Enumeration date
08/09/2010
Last updated
07/22/2011
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