Individual
MS. JENEFER JUNE SOUTHWICK
Active
Individual
MS. JENEFER JUNE SOUTHWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7977
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7977
STATE LISCENSE
MN
Enumeration date
04/16/2007
Last updated
06/15/2025
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