Healthcare Provider Details

I. General information

NPI: 1861425472
Provider Name (Legal Business Name): JAN M BEXELL-GIERKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN M BEXELL

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8000
  • Fax: 701-364-8078
Mailing address:
  • Phone: 701-364-3300
  • Fax: 701-364-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10079
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: