Provider Demographics
NPI:1114074135
Name:NAISER, JENNIFER A (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:NAISER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PAUL BUNYAN DR NW # 279
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2433
Mailing Address - Country:US
Mailing Address - Phone:817-679-3912
Mailing Address - Fax:
Practice Address - Street 1:24760 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:817-579-3969
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61788207RC0000X
TXL6646207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01253772OtherAMERIGROUP
TX8CC832OtherBCBS
TX8L8489Medicare PIN
TX01253772OtherAMERIGROUP
TX8L10119Medicare PIN
TXP00695571Medicare PIN