Individual
SUSAN M JAGODZINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1013 HART BLVD, MONTICELLO, MN 55362-8575
(763) 271-2248
(763) 271-2890
Mailing address
10749 KILBURY AVE SW, HOWARD LAKE, MN 55349-5519
(320) 543-2288
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R101747-4
MN
207Q00000X
Family Medicine Physician
9714
MN
363A00000X
Physician Assistant
Primary
9714
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
388243800
—
MN
Enumeration date
03/24/2006
Last updated
06/25/2021
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