Healthcare Provider Details

I. General information

NPI: 1013663442
Provider Name (Legal Business Name): JENNY LYNN SAILER SAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 68TH AVE
GLEN ULLIN ND
58631
US

IV. Provider business mailing address

PO BOX 683
GLEN ULLIN ND
58631-0683
US

V. Phone/Fax

Practice location:
  • Phone: 701-880-1297
  • Fax:
Mailing address:
  • Phone: 701-880-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: