Healthcare Provider Details

I. General information

NPI: 1932120276
Provider Name (Legal Business Name): JEANNE A UNTERSEHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MAIN ST E
MAYVILLE ND
58257-1606
US

IV. Provider business mailing address

730 MAIN ST E
MAYVILLE ND
58257-1606
US

V. Phone/Fax

Practice location:
  • Phone: 701-786-4500
  • Fax: 701-786-4545
Mailing address:
  • Phone: 701-786-4500
  • Fax: 701-786-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR25877
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: