Healthcare Provider Details

I. General information

NPI: 1871830422
Provider Name (Legal Business Name): JENNA L FICEK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA L STEIER

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501-4439
US

IV. Provider business mailing address

PO BOX 997
BISMARCK ND
58502-0997
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6000
  • Fax: 701-323-5918
Mailing address:
  • Phone: 701-530-7000
  • Fax: 701-530-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR33436
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: