Individual
MR. JACOB KOHL PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN CNP
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R51672
ND
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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