Healthcare Provider Details

I. General information

NPI: 1164001178
Provider Name (Legal Business Name): JENNY DELORIES BAINTER WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N EAST ST
HEBRON ND
58638-7129
US

IV. Provider business mailing address

227 N EAST ST
HEBRON ND
58638-7129
US

V. Phone/Fax

Practice location:
  • Phone: 701-946-8318
  • Fax:
Mailing address:
  • Phone: 701-946-8318
  • 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: