Healthcare Provider Details

I. General information

NPI: 1992641823
Provider Name (Legal Business Name): JESSE PELTIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N 55TH ST UNIT 112
GRAND FORKS ND
58203-1707
US

IV. Provider business mailing address

1100 N 55TH ST UNIT 112
GRAND FORKS ND
58203-1707
US

V. Phone/Fax

Practice location:
  • Phone: 701-550-9985
  • Fax:
Mailing address:
  • Phone: 701-550-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: