Provider Demographics
NPI:1033683826
Name:OSSEFOORT, JESSICA JEAN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:OSSEFOORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:COLERAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55722-0007
Mailing Address - Country:US
Mailing Address - Phone:218-259-4043
Mailing Address - Fax:
Practice Address - Street 1:302 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1772
Practice Address - Country:US
Practice Address - Phone:218-421-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN733543183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician