Healthcare Provider Details

I. General information

NPI: 1346049756
Provider Name (Legal Business Name): JENNIFER L KRUEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 8TH ST N
FARGO ND
58102-1430
US

IV. Provider business mailing address

3122 8TH ST N
FARGO ND
58102-1430
US

V. Phone/Fax

Practice location:
  • Phone: 701-793-1602
  • Fax:
Mailing address:
  • Phone: 701-793-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: