Individual
JACQUELINE F MAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1687 WOODLANE DR, SUITE 101, WOODBURY, MN 55125-3045
(651) 209-6263
(651) 209-6264
Mailing address
1687 WOODLANE DR, SUITE 101, WOODBURY, MN 55125-3045
(651) 209-6263
(651) 209-6264
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
40062
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0702247
MEDICA
MN
01
—
120389F210
UCARE
MN
01
—
160056510
RR MEDICARE
MN
01
—
34454200
WISCONSIN MEDICAID
WI
01
—
56F15MA
BLUE CROSS BLUE SHIELD
MN
05
—
585517900
—
MN
01
—
764114
ARAZ
MN
01
—
NA3501014502
PREFERRED ONE
MN
Enumeration date
06/07/2006
Last updated
05/02/2018
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