Healthcare Provider Details

I. General information

NPI: 1952042533
Provider Name (Legal Business Name): MRS. BLESSING GEORGE-CHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 CIRCLE DR
JAMESTOWN ND
58401-6905
US

IV. Provider business mailing address

806 16 1/2 ST NE
JAMESTOWN ND
58401-2733
US

V. Phone/Fax

Practice location:
  • Phone: 540-256-3684
  • Fax:
Mailing address:
  • Phone: 540-256-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR49947
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201915
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: