Healthcare Provider Details

I. General information

NPI: 1528398658
Provider Name (Legal Business Name): JAIME R BELCOURT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 W AVENUE B
BISMARCK ND
58501-3452
US

IV. Provider business mailing address

716 W AVENUE B
BISMARCK ND
58501-3452
US

V. Phone/Fax

Practice location:
  • Phone: 406-788-3215
  • Fax:
Mailing address:
  • Phone: 406-788-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number174441
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number30020
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR55077
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: