Provider Demographics
NPI:1669987822
Name:DIDIER, JENNIFER JOSEPHINE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOSEPHINE
Last Name:DIDIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOSEPHINE
Other - Last Name:SNAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 EARLE BROWN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2506
Practice Address - Country:US
Practice Address - Phone:952-993-4900
Practice Address - Fax:952-993-4827
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant