Basic Information
| Provider Information | |||||||||
| NPI: | 1386738995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYMAN | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 420 DELAWARE ST SE MMC292 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637826400 | ||||||||
| FaxNumber: | 7637829558 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPT OF OB/GYN & WOMEN'S HEALTH | ||||||||
| Address2: | 420 DELAWARE STREET SE MMC 395 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637826400 | ||||||||
| FaxNumber: | 7637829558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | R 138190-6 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 04-08300 | 01 | MN | MEDICA - CHOICE | OTHER | B612 | 01 | MN | CHAMPUS | OTHER | 502K7WY | 01 | MN | BCBS | OTHER | 04-04568 | 01 | MN | MEDICA - PRIMARY | OTHER | HP27464 | 01 | MN | HEALTHPARTNERS | OTHER | 2378192 | 01 | MN | ARAZ | OTHER | 41262700 | 05 | WI | MEDICAID | 0715078 | 05 | IA | MEDICAID | 1019243 | 01 | MN | PREFERRED ONE | OTHER | 123361 | 01 | MN | UCARE | OTHER | 4305977 | 05 | MT | MEDICAID | 84536-2 | 01 | MN | FAIRVIEW CAREGIVE | OTHER |