Provider Demographics
NPI:1710419395
Name:SJOHOLM, JESSICA SIMMONS (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SIMMONS
Last Name:SJOHOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4194 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6106
Mailing Address - Country:US
Mailing Address - Phone:516-483-5461
Mailing Address - Fax:651-483-2155
Practice Address - Street 1:4194 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-6106
Practice Address - Country:US
Practice Address - Phone:516-483-5461
Practice Address - Fax:516-483-2155
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2021-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN66335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine