Basic Information
| Provider Information | |||||||||
| NPI: | 1801993340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERSTEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7505 METRO BLVD 400 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554393010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET MALL | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 10/19/2015 | ||||||||
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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 | 2085R0202X | T102711 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 452L4KE | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 1047601 | 01 | MN | PREFERRED ONE | OTHER | 172155000 | 05 | MN | MEDICAID | P00349001 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 0732909 | 05 | IA | MEDICAID | 133245 | 01 | MN | UCARE | OTHER | 34716600 | 05 | WI | MEDICAID | HP69501 | 01 | MN | HEALTHPARTNERS | OTHER | 1604280 | 01 | MN | MEDICA | OTHER |