Jennifer Poethke Idiculla, PA-C

NPI #1841661824 in Saint Michael, Minnesota

Provider Information

NPI Number: 1841661824
Entity Type: Individual
Name: Jennifer Poethke Idiculla, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 15, 2015
Last Updated: Jan 12, 2023

Practice Location

Address: 4300 EDGEWOOD DR NE
City: Saint Michael
State: Minnesota
ZIP Code: 55376-4588
Phone: (763) 744-4000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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