Individual
MRS. JACQUELINE M SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1961 PREMIER DR STE 330, MANKATO, MN 56001-6494
(507) 420-4681
Mailing address
1961 PREMIER DR STE 330, MANKATO, MN 56001-6494
(507) 420-4681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/25/2009
Last updated
04/28/2015
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