Jessica Lin Omdahl, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10863 Issued in MN

Practice address

715 Delmore Dr
Roseau, MN 56751-1599

Phone

(218) 463-4732

Fax

(218) 463-4778

NPI assigned

Oct 12, 2023

Last updated

Oct 12, 2023By the provider in NPPES

Sex

Female

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095
  Medicare reassignment NPD

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

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1881475192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511599",
            "telephone_number": "218-463-4732",
            "fax_number": "218-463-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511599",
            "telephone_number": "218-463-4732",
            "fax_number": "218-463-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMDAHL",
        "first_name": "JESSICA",
        "middle_name": "LIN",
        "credential": "APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-12",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "10863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prasad Munusamy, M.D.
• Erin Murray
• Randy Ray Olson, P.T.
• Ross Olson
• Samantha Jo Olson, CNP
• Lindsay Palmquist, DPT
• Michael Pelowski
• Julie Mae Przekwas
• Rachel Renee Przekwas, LADC, LSW
• Riverview Healthcare Association (Riverview Recovery Center)

• Psychiatric/Mental Health Nurse Practitioner in Roseau, MN
• Providers in Roseau, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.