Healthcare Provider Details

I. General information

NPI: 1114309028
Provider Name (Legal Business Name): CARA JAHNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4530
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-4516
  • Fax: 701-712-4164
Mailing address:
  • Phone: 701-712-4500
  • Fax: 701-712-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR36271
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: