Jesse Lee Fladmark, PA-C, ATC
Physician Assistant in Eagan, MN. Individual provider (NPI-1).
NPI number1295019388
StatusActive
Last updated in NPPESMay 19, 2023
Details
- NPI
- 1295019388
- Entity type
- Individual (NPI-1)
- Name
- Jesse Lee Fladmark
- Credential
- PA-C, ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 6, 2011
- Certification date
- May 19, 2023
- Last updated
- May 19, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 12157 | MN | Yes |
Practice location
1654 Diffley Rd100
Eagan, MN 55122-2237
Phone 651-641-3900
Mailing address
8170 33rd Ave SMs 21110q
Bloomington, MN 55425-4516
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All 50 Physician Assistant providers in Eagan · All 2,108 providers in Eagan
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