Basic Information
| Provider Information | |||||||||
| NPI: | 1730643701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 BROADWAY ST NE STE 115 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554131759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121505 | ||||||||
| FaxNumber: | 6513121570 | ||||||||
| Practice Location | |||||||||
| Address1: | 11850 BLACKFOOT ST NW STE 270 | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121717 | ||||||||
| FaxNumber: | 6513121570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 12789 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.