Individual
JENNIFER DEBRA KISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
8307 KIMBALL DR, EDEN PRAIRIE, MN 55347-2127
(612) 324-9111
Mailing address
1157 JUBERT TRL, MEDINA, MN 55340-3707
(952) 412-7019
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
CNP0023
MN
363LG0600X
Gerontology Nurse Practitioner
R1722659
MN
Other
Enumeration date
04/08/2008
Last updated
08/28/2021
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