Healthcare Provider Details

I. General information

NPI: 1508083015
Provider Name (Legal Business Name): JAMIE TODD KLEINKNECHT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5013 WAGON WHEEL CIR
MANDAN ND
58554-1050
US

IV. Provider business mailing address

5013 WAGON WHEEL CIR
MANDAN ND
58554-1050
US

V. Phone/Fax

Practice location:
  • Phone: 701-663-5452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR29443
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR29443
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR29443
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: