Jacob Leon Walgrave, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2457452 Issued in MN

Practice address

1 Veterans Dr
Minneapolis, MN 55417-2309

Phone

(612) 467-2111

NPI assigned

Jul 18, 2017

Last updated

Jul 18, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500336000000",
    "number": "1275056582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550920126",
            "telephone_number": "651-955-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554172309",
            "telephone_number": "612-467-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALGRAVE",
        "first_name": "JACOB",
        "middle_name": "LEON",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-18",
        "last_updated": "2017-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2457452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert S Waldon, CRNA
• Eric John Waldron, PH.D., LP, ABPP
• Laura Beth Waldt, PHARM.D RPH
• Stephanie Michelle Walek
• Celeste Walgrave
• Walgreen Co (Walgreens #16279)
• Walgreen Co (Walgreens #02038)
• Walgreen Co (Walgreens #04119)
• Walgreen Co (Walgreens #01303)
• Walgreen Co (Walgreens Specialty Pharmacy #11916)

• Registered Nurse in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.